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Haloperidol

Oral
Intramuscular
Class
Antipsychotics
Subclass
Butyrophenones
Substance name
Haloperidol
Common formulations
Solution, Tablet
See also
Haloperidol decanoate LA (Haldol®)
Dosage and administration
Adults patients
Treatment
Psychotic disordersModerate symptoms
Start at: 0.5-2 mg PO BID-TID
Maximum: 100 mg per day
Titrate to the lowest effective maintenance dose once satisfactory therapeutic response is achieved.
Psychotic disordersSevere symptoms
Start at: 3-5 mg PO BID-TID
Maximum: 100 mg per day
Titrate to the lowest effective maintenance dose once satisfactory therapeutic response is achieved.
Tourette's syndromeModerate symptoms
Start at: 0.5-2 mg PO BID-TID
Maximum: 100 mg per day
Titrate to the lowest effective maintenance dose once satisfactory therapeutic response is achieved.
Tourette's syndromeSevere symptoms
Start at: 3-5 mg PO BID-TID
Maximum: 100 mg per day
Titrate to the lowest effective maintenance dose once satisfactory therapeutic response is achieved.
DeliriumOff-label
Maintenance: 0.5-1 mg PO QID PRN
Maximum: 30 mg per day
Delirium in patients with advanced cancerOff-label
0.5-4 mg PO daily
Nausea and vomiting in patients with advanced cancerOff-label
1.5-5 mg PO q4-6h
Adjunctive treatment
Adjunctive treatment for alcohol withdrawal syndromeOff-label
0.5-5 mg PO q4h
Administered in combination with benzodiazepines.
Other off-label uses
Treatment of OCD
Indications for use
Labeled indications
Adults
Treatment of Tourette's syndrome (moderate symptoms)
Treatment of Tourette's syndrome (severe symptoms)
Treatment of psychotic disorders (moderate symptoms)
Treatment of psychotic disorders (severe symptoms)
Off-label indications
Adults
Treatment of delirium
Treatment of delirium in patients with advanced cancer
Treatment of nausea and vomiting in patients with advanced cancer
Treatment of OCD
Adjunctive treatment for alcohol withdrawal syndrome
Safety risks
Boxed warnings
Increased risk of mortality
Do not use haloperidol in elderly patients with dementia-related psychosis because of the increased risk of mortality.
Contraindications
Hypersensitivity to haloperidol or its components
Dementia with Lewy Bodies
Severe toxic CNS depression or comatose states from any cause
Warnings and precautions
Cerebrovascular events
Use caution in patients with risk factors for cerebrovascular adverse reactions.
CNS depression
Use caution in patients receiving CNS depressants, such as anesthetics or opioids, or using alcohol.
Decreased WBC count, decreased blood neutrophil count
Maintain a high level of suspicion, as haloperidol has been associated with an increased risk of leukopenia, neutropenia, and agranulocytosis. Discontinue haloperidol in case of severe neutropenia (absolute neutrophil count < 1,000/mcL).
Depression
Use caution in patients receiving haloperidol to control mania in cyclic disorders.
Dyskinesia
Do not discontinue abruptly in patients taking the drug for a prolonged period.
Encephalopathy
Use caution in patients receiving concomitant therapy with lithium.
Extrapyramidal signs
Use caution in patients receiving concomitant therapy with antiparkinsonian agents. Consider continuing antiparkinsonian therapy after haloperidol is discontinued because of the difference in excretion rates.
Falls
Maintain a high level of suspicion, as haloperidol has been associated with an increased risk of motor instability, somnolence, and orthostatic hypotension, leading to falls and fall-related injuries.
Hypotension, angina pectoris
Use caution in patients with severe cardiovascular disorders.
Increased serum haloperidol levels
Use caution in patients receiving CYP3A4 inhibitors (such as alprazolam, itraconazole, ketoconazole, nefazodone, ritonavir), CYP2D6 inhibitors (such as chlorpromazine, promethazine, quinidine, paroxetine, sertraline, venlafaxine), combined CYP3A4 and CYP2D6 inhibitors (fluoxetine or fluvoxamine with ritonavir), or buspirone. Consider decreasing haloperudol dose as necessary.
Increased serum prolactin
Maintain a high level of suspicion, as antipsychotic drugs can elevate prolactin levels, with elevation persisting during chronic administration.
Neuroleptic malignant syndrome
Maintain a high level of suspicion, as haloperidol has been associated with an increased risk of neuroleptic malignant syndrome. Discontinue haloperidol immediately if neuroleptic malignant syndrome develops.
Neurotoxicity
Use caution in patients with thyrotoxicosis.
Prolonged QT interval, torsade de pointes
Use caution in patients receiving higher than recommended doses of haloperidol, intravenous haloperidol, as well as in patients with other QT-prolonging conditions, such as hypokalemia, hypomagnesemia, hypocalcemia, underlying cardiac abnormalities, familial long QT syndrome, hypothyroidism, or concomitant therapy with other QT-prolonging agents.
Seizure
Use caution in patients with a history of seizures, EEG abnormalities, or receiving anticonvulsant medications.
Somnolence, motor impairment
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Tardive dyskinesia
Maintain a high level of suspicion, as haloperidol has been associated with an increased risk of tardive dyskinesia, especially in elderly women.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
Use acceptable. No dose adjustment required.
Renal replacement therapy
Peritoneal dialysis
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
Use acceptable. No dose adjustment required. Haloperidol concentrations may increase in patients with hepatic impairment, as it is primarily metabolized by the liver and protein binding may decrease.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
Use only if benefits outweigh potential risks. Evidence of fetal harm in humans. Monitor neonates for extrapyramidal and/or withdrawal symptoms.
Adverse reactions
Unknown frequency
Tachycardia, hypotension, hypertension, ↑QT interval, ventricular arrhythmia, extrapyramidal signs, akathisia, dystonia, parkinsonism, dysphagia, dyspnea, tardive dyskinesia, dyskinesia, insomnia, restlessness, euphoria, agitation, depression, anxiety, lethargy, headache, confusion, vertigo, seizure, hallucinations, behavioral or personality changes, hyperpyrexia, ↓ WBC count, ↓ blood neutrophil count, agranulocytosis, anemia, ↑ LFTs, jaundice, maculopapular rash, acneiform lesions, hair loss, photosensitivity of skin, breast enlargement, mastalgia, menstrual irregularity, gynecomastia, erectile dysfunction, ↑ libido, ↑ blood glucose, ↓ blood glucose, ↓ serum sodium, loss of ability to do everyday tasks, constipation, diarrhea, hypersalivation, nausea, vomiting, dry mouth, blurred vision, urinary retention, diaphoresis, priapism, laryngospasm, bronchospasm, visual disturbances, ↑ blood ammonia, orthostatic hypotension, falls, ↑ serum prolactin, torsades de pointes, neuroleptic malignant syndrome, cataract, oculogyric crisis
Interactions
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