Increase haloperidol by 1-2 mg every other day until the patient first shows slight parkinsonism, or begins to improve. (1) Any obvious or coarse rigidity or any pill-rolling rhythmic tremor that develops should be immediately addressed with dosage adjustment downward until the parkinsonism is barely detected. Check plasma levels and ensure that the final dose exceeds 5 nanograms per ml. If there is still no response, go back to the question (three questions back) when you were asked if the patient's haloperidol level was over 5 ng/ml. (or click here to go back there now) Answer yes, and proceed with the algorithm.
Using this method, anticholinergic prophylaxis of acute dystonias should not usually be necessary, unless there is a history of problems of this type.
Recommendation #150
