benperidol: clinical use

Prescribing considerations

• Initiate and adjust under close clinical supervision because response and susceptibility to extrapyramidal effects vary.
• Review cardiovascular disease, family history of sudden death or QT prolongation, electrolyte disturbance, epilepsy, hepatic or renal impairment and stroke risk.
• Assess venous-thromboembolism risk before and during treatment.
• Avoid abrupt withdrawal; consider gradual discontinuation because withdrawal symptoms and relapse can occur.
• The product is not licensed for dementia-related behavioural disturbance.

Contraindications and cautions

• Hypersensitivity to benperidol, an excipient or another butyrophenone.
• Comatose states or central nervous system depression.
• Existing extrapyramidal symptoms.
• Depressive disorders.
• Parkinson's disease.
• Rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption because the tablets contain lactose.

Monitoring

• Consider baseline ECG and calcium, magnesium and potassium, particularly with cardiac risk, older age or abnormal cardiovascular examination.
• Repeat ECG and electrolytes when clinically indicated; correct electrolyte abnormalities.
• For prolonged treatment, consider regular full blood counts and liver-function tests.
• Monitor for extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, hypotension, prolactin effects and venous thromboembolism.

Clinical pharmacology

A potent butyrophenone neuroleptic whose principal therapeutic and extrapyramidal effects reflect strong dopamine D2-receptor antagonism.

Formulation and product differences

• The selected UK product is an oral, white tablet containing lactose, starch and magnesium stearate.
• The tablet has a breakline, but the product information does not state that it provides equal divided portions.
• Protect the tablets from light.