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The Annals of Pharmacotherapy: Vol. 37, No. 10, pp. 1434-1437. DOI 10.1345/aph.1C389
© 2003 Harvey Whitney Books Company.
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Delayed Onset of Oculogyric Crisis and Torticollis with Intramuscular Haloperidol

Stanford S Jhee, PharmD

Director of Research, California Clinical Trials Medical Group, Glendale, CA

Victoria Zarotsky, PharmD

Research Scientist, California Clinical Trials Medical Group

Stephen M Mohaupt, MD

Research Psychiatrist, California Clinical Trials Medical Group

Cynthia L Yones, RN

Inpatient Department Manager, California Clinical Trials Medical Group

Steve J Sims, RN

Clinical Research Coordinator, California Clinical Trials Medical Group

Reprints: Stanford S Jhee PharmD, California Clinical Trials Medical Group, 1509 Wilson Terrace, 55 Wing, Main Floor, Glendale, CA 91206-4007, FAX 818/545-0054, stan.jhee{at}cctrials.com

OBJECTIVE: To report a case of delayed-onset dystonic reactions, oculogyric crisis (OGC), and torticollis after treatment with intramuscular haloperidol lactate injection.

CASE SUMMARY: A 22-year-old Mexican American woman received intramuscular haloperidol lactate 7.5 mg followed 4 hours later by 10 mg. Twenty-six hours after the first injection, the patient reported that she was unable to lower her gaze and that her neck was stiff. She was immediately given intramuscular benztropine 2 mg; there was a nearly complete remission of symptoms within 15 minutes of treatment. An objective causality assessment revealed a probable relationship between the OGC/torticollis and haloperidol therapy.

DISCUSSION: Dystonic reactions have been reported in 10-60% of patients treated with neuroleptic medication, most commonly when patients just start or increase the dose of the drug. The highest frequency of dystonic reactions has occurred in patients receiving high-potency neuroleptics. It has also been suggested that haloperidol-induced dystonic reactions are a result of the toxic metabolites of that agent.

CONCLUSIONS: OGC and torticollis reactions may occur 12-24 hours after treatment with a high-potency neuroleptic, even in the absence of symptoms of extrapyramidal side effects (EPSEs). The delayed dystonic reaction may begin suddenly (no early EPSE symptomatology).

Key Words: dystonic reaction, haloperidol, oculogyric crisis

Published Online, August 15, 2003. www.theannals.com, DOI 10.1345/aph.1C389




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