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Serum haloperidol concentration and choreiform movements in Huntington's disease

Department of Neurology (Drs. Barr and Singhal), College of Medicine, and the Department of Pharmacy Practice (Dr. Fischer and Mr. Spunt), College of Pharmacy, University of Illinois at Chicago, IL; and the Department of Neurology (Dr. Roller), Hines Veterans Administration Hospital, Loyola University Medical Center, Maywood, IL. Dr. Roller is now at the Department of Neurology, University of Kansas, Kansas City, RS.

The relationship between serum haloperidol concentration and improvement in abnormal movements was investigated in 20 adult Huntington's disease (HD) patients. Serum samples and assessments of severity of chorea were simultaneously obtained from each patient. Data were obtained prior to and at one or more doses following the initiation of haloperidol in ten patients. Serum was analyzed for haloperidol by two different methods, gas chromatographic/mass spectrometric (GC/MS) and radioreceptor (RR) assays. Steady-state serum haloperidol concentrations (GC/MS) of 0. 5 to 24 ng/ml were observed following administration of doses of 1 to 40 mg/d and varied markedly between patients. Only results from the GC/MS assay were used for examining relationships with dose and clinical response because of insensitivity of RR assay. Significant improvement of abnormal movements, greater than 30% from baseline, occurred at serum concentrations between 2 and 5 ng/ml, which corresponded to doses of 1. 5 to 10 mg/d. Further improvement in abnormal movements at serum concentrations above this range was minimal.

Address correspondence and reprint requests to Dr. Barr, Department of Neurology (m/c 796), University of Illinois at Chicago, 912 South Wood Street, Room 855, Chicago, IL 60612.

Received August 14, 1986. Accepted for publication in final form March 2, 1987.

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