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Plasma Haloperidol Levels: Clinical Response and Fancy Mathematics

Theodore Van Putten, MD; Stephen R. Marder, MD; Jim Mintz, PhD
Arch Gen Psychiatry. 1985;42(8):835. doi:10.1001/archpsyc.1985.01790310103014.
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To the Editor.—  The article by Smith et al1 on the relation between plasma haloperidol levels and clinical response suggests a "therapeutic window" relationship with a therapeutic plasma level range between 7.0 and 17.0 ng/mL for hospitalized schizophrenic patients. That is, above 17.0 ng/mL the patient's condition may either fail to improve or even worsen. If this is true (and if it applies to the usual newly [re]admitted schizophrenic patient), our work2 and that of Itoh et al3 would indicate that the majority of inpatient schizophrenics in the western world are in the psychotoxic plasma-level range!Itoh and colleagues,3 in a series of 135 schizophrenic patients, and our group,2 in a series of 70 patients, found respective correlations of.77 and.82 between dose and haloperidol plasma level. We attribute these high and very comparable correlations to good compliance (we will not enter a patient into the

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