Personalized approach to prediction and prevention of haloperidol-induced metabolic syndrome

Haloperidol (HLP) is a general medication in the treatment of psychotic disorders such as schizophrenia and acute mania. One of HLP’s advantages compared to other antipsychotics, such as olanzapine or clozapine, is its relatively low risk of significant weight gain, making it more suitable for patients requiring strict weight control. However, despite this comparatively favorable profile, some patients may experience moderate weight gain with long-term use of HLP. This side effect can be attributed to several factors. First, HLP affects metabolic processes, which may lead to changes in appetite and reduced physical activity. Second, the drug can increase prolactin levels, which is associated with the development of hyperprolactinemia—a condition that may contribute to weight gain and the emergence of other components of metabolic syndrome, such as insulin resistance. Third, HLP may promote increased oxidative stress, which plays an important role in the pathogenesis of metabolic disorders. These mechanisms underscore the need for monitoring patients on HLP to promptly detect and manage potential metabolic side effects. Objective : To update the knowledge of practicing psychiatrists and clinical pharmacologists about a personalized approach to the prevention of metabolic syndrome in patients with psychiatric disorders when taking HLP. Methods : Full-text articles published from 01.09.2013 to 01.09.2024 were searched in PubMed, Science Direct, eLIBRARY.RU, and Google Scholar. Results : This review analyses and summarizes the results of foreign and domestic studies on the effect of haloperidol on the development of metabolic syndrome, the role of risk factors and hereditary predisposition in the development of HLP -induced metabolic syndrome in patients with psychiatric disorders. Conclusion : Generalized data on the effect of HLP on the development of metabolic syndrome in patients with psychiatric disorders may be required by psychiatrists and clinical pharmacologists when selecting the dose and duration of haloperidol administration. Predictive pharmacogenetic testing may help to reduce the probability of this adverse drug reaction and increase the compliance of haloperidol therapy.