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


METHODS
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.


CONCLUSIONS
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).
D000328:Adult; D004421:Dystonia / Q000139:chemically induced / Q000150:complications; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D006801:Humans; D007273:Injections, Intramuscular; D015835:Ocular Motility Disorders / Q000139:chemically induced* / Q000150:complications* / Q000175:diagnosis; D012563:Schizophrenia, Paranoid / Q000150:complications / Q000188:drug therapy; D013997:Time Factors; D014103:Torticollis / Q000139:chemically induced* / Q000150:complications* / Q000175:diagnosis
D006220:Haloperidol