Probable haloperidol decanoate-induced fever in an African American with benign ethnic neutropenia: A case report

We present a case in which a patient developed fever and leukocytosis subsequent to each monthly haloperidol decanoate injection, an adverse reaction that does not meet the diagnostic criteria of neuroleptic malignant syndrome (NMS) or any previously reported adverse reaction for this medication. A patient being treated with haloperidol decanoate for psychosis experienced a fever within 3 days of injection and leukocytosis along with swelling, pain, and a “knot” feeling at the injection site. This recurred after each injection for several months. Muscle rigidity or changes in vital signs other than temperature were not noted. Temperature and injection site reactions resolved with administration of acetaminophen and ibuprofen. The elevation in temperature was discovered as a result of universal twice daily temperature monitoring implemented due to the COVID-19 pandemic. Reports of fever with antipsychotics are typically associated with NMS or heat stroke; the details of this case do not meet the clinical criteria for either. Similar reactions are reported for other antipsychotics, such as clozapine and olanzapine, but not for haloperidol. The recommendation was to discontinue use of the medication due to an unclear mechanism of the reaction.

The Role of Antypsychotic Therapy in the Development of Akathisia in Patients with Schizophrenia

The use of antipsychotic therapy in patients with schizophrenia is associated with the development of a wide range of adverse events, among which akathisia is one of the most common. Objective: to assess the risk of akathisia in patients with schizophrenia receiving various antipsychotic therapy. Patients and methods. A continuous method examined 250 inpatients with a verified diagnosis of schizophrenia. The akathisia assessment was performed using the Barnes Akathisia Rating Scale (BARS). The odds ratio was estimated using the MedCalc® online calculator. Results: akathisia was detected in 92 (36.8%) examined. The combination of two antipsychotic drugs has an increased risk of akathisia in patients with schizophrenia OR = 1.69 (95% CI: 1.0–2.88; p = 0.04), however the use of conventional and atypical drugs was associated with a reduction in risk (OR = 0.45 (95% CI: 0.21–0.95; p = 0.037)). Patients receiving basic therapy zuclopenthixol decanoate had increased risk of akathisia 4 times as compared to haloperidol decanoate (OR = 3.85 (95% CI: 1,26–12,22; p = 0.021)). Conclusions: It was shown that the choice of antipsychotic therapy should be based not only on the actual mental state of the patient, but also considering the potential risk of akathisia.