It is very important for patients to not feel too discouraged if the first medications used are less than optimally effective or that there are problematic side effects. A sign of a competent and compassionate psychiatrist is her willingness to be persistent in carrying out systematic medication trials until the best treatment is finally identified. Sometimes side effects can be minimized; however, many people end up having to find ways to tolerate some side effects. Obviously, this is not pleasant, but is ultimately necessary to reduce or eliminate severe mood swings. Unfortunately, a very small number of people are simply unable to tolerate any bipolar medications.
The influence of renal impairment on the pharmacokinetics of haloperidol has not been evaluated. About one-third of a haloperidol dose is excreted in urine, mostly as metabolites. Less than 3% of administered haloperidol is eliminated unchanged in the urine. Haloperidol metabolites are not considered to make a significant contribution to its activity, although for the reduced metabolite of haloperidol, back-conversion to haloperidol cannot be fully ruled out. Even though impairment of renal function is not expected to affect haloperidol elimination to a clinically relevant extent, caution is advised in patients with renal impairment, and especially those with severe impairment, due to the long half-life of haloperidol and its reduced metabolite, and the possibility of accumulation (see section ).
There are no well controlled studies with Haldol (haloperidol) in pregnant women. There are reports, however, of cases of limb malformations observed following maternal use of Haldol along with other drugs which have suspected teratogenic potential during the first trimester of pregnancy. Causal relationships were not established in these cases. Since such experience does not exclude the possibility of fetal damage due to Haldol, this drug should be used during pregnancy or in women likely to become pregnant only if the benefit clearly justifies a potential risk to the fetus.