Bromperidol is one of the active ingredients contained in the classic neuroleptics. The highly potent substance has a strong antipsychotic effect. It is one of the successor substances to haloperidol, which found widespread use in psychiatric hospitals under the label Haldol beginning in the mid-1960s.
What is bromperidol?
Bromperidol is one of the active ingredients found in classic neuroleptics. Bromperidol has the molecular formula C21H23BrFNO2 and is an active substance that is particularly effective in combating the positive symptoms of schizophrenia (hallucinations, delusional thoughts, etc.). It was marketed under the brand names Bromidol and Bromodol after its development by Janssen Pharmaceutica in 1966. Today, it is also contained in the drugs Impromen and Tesoprel, for example. Bromperidol belongs to the class of butyrophenones used exclusively for the treatment of schizophrenia. The members of this drug group all have a 1-phenyl-1-butenone building block. Since bromperidol was among the first antipsychotics synthesized at the time, it is considered a classic or typical neuroleptic. Because of its strong anti-psychotic properties, it is a highly potent agent, as even a low dose of bromperidol achieves a high effect. However, as a strong antipsychotic, it is only weakly sedating. It cannot regulate inner restlessness, sleep disturbances, anxiety, and states of agitation such as occur during a psychotic episode. Therefore, bromperidol is usually administered with a low-potency neuroleptic in acute psychosis.
Pharmacologic effects
The positive symptoms of schizophrenic psychosis are commonly believed to be caused by an excessive concentration of the neurotransmitter dopamine in the meso-limbic part of the brain. Bromperidol, like the other representatives of its drug group, is able to block the release of the neurotransmitter by acting as a D2 receptor antagonist. The reality misperceptions, misperceptions, and psychomotor agitation diminish. However, unless a neuroleptic with a strong sedative effect is administered at the same time, negative symptoms may be exacerbated. Even with bromperidol, schizophrenia can only be treated symptomatically. However, the patient becomes calm and is able to perceive his condition as pathological.
Medical use and application
Before treatment with bromperidol, a blood count is obtained, supplemented by a differential blood count. The dosage of the drug is individualized. The mean dose is considered to be 5 to 20 mg of bromperidol daily. The maximum dose is considered to be 50 mg. In acute therapy, as with other neuroleptics, a higher dose is administered than in long-term and relapse prophylaxis. In long-term therapy, the patient receives the drug along with his meal. The effect is rapid after initial administration: symptoms such as auditory and visual hallucinations and paranoid ideation usually subside soon. Bromperidol has an anti-psychotic effect 50 times stronger than chlorpromazine. Chlorpromazine was the first neuroleptic agent at the time and is used as a reference in efficacy comparisons of the classic neuroleptics. Bromperidol, unlike low-potency agents for schizophrenia, does not cause drowsiness and also does not cause hypotension, which reduces the risk of circulatory collapse.
Risks and side effects
As a highly potent anti-psychotic agent, bromperidol also has many side effects, the worst of which is extrapyramidal syndrome (EPS). Patients then experience Parkinson’s-like symptoms with muscle stiffness (rigor), sitting restlessness, tremors, etc. Therefore, people with schizophrenia with this sequelae are given additional anticholinergics. Bromperidol treatment causes a structural change in brain matter depending on the dose level and duration of therapy. In animal studies, brain volume and weight (neuro-degeneration) were found to be reduced by about 10%.Most common side effects that may occur while taking bromperidol are white blood cell deficiency (leukopenia), reduction in blood cell count (anemia), hair loss, early and tardive dyskinesia, extrapyramidal syndrome, respiratory distress, pneumonia, thromboembolism, Parkinson’s disease symptoms, involuntary movements such as gaze, swallowing and tongue spasms, and extreme agitation. Occasionally, hypotension, accelerated heart rate, and peripheral edema may occur. In rare cases, diarrhea, nausea, vomiting, loss of appetite, vegetative symptoms, allergic reactions, drowsiness, cerebral seizures, impaired speech and memory, sleep problems, malignant neuroleptic syndrome, and depressed mood have been observed. Bromperidol should not be used in patients with comatose states, paragroup allergy, children under 12 years of age, and individuals who have cardiac, renal, hepatic insufficiency, prostate enlargement with residual urine formation, acute urinary retention, severe hypotension, Parkinson’s disease, endogenous depression, brain organic disease, severe epilepsy, hyperthyroidism, a known allergy to the active ingredient, glaucoma, myocardial infarction, and acute drug or alcohol dependence. Animal studies have demonstrated damage to fertility. Although findings on similar effects in humans are not yet available, the active substance should only be used with extreme caution in pregnant women. Children of mothers who received bromperidol during lactation later showed extrapyramidal symptoms. Patients with cardiac impairment and the elderly could experience impaired conduction of cardiac excitation. Since bromperidol, like other neuroleptics, promotes the release of prolactin, which is considered an initiating substance in some cancers, such as breast cancer, it should also be used in patients with breast cancer only when urgently indicated. The same applies to people with pathological blood levels. In all these cases, regular medical monitoring of patients must be ensured. Since the active substance lowers the seizure threshold in epileptics, for example, it may only be administered to them if they are also receiving anticonvulsants. Alcoholic beverages and sedatives enhance the effect of bromperidol, but tea, coffee, and other caffeinated beverages weaken its effect.
