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Haloperidol

Medical and Pharmacy Editor:

Brand Name: Haldol, Haldol Decanoate, Haloperidol LA, Peridol

Generic Name: Haloperidol

Drug Class: Antipsychotics, 1st Generation

What Is Haloperidol and How Does It Work?

Haloperidol is used to treat certain mental/mood disorders (e.g., schizophrenia, schizoaffective disorders). This medicine helps you to think more clearly, feel less nervous, and take part in everyday life. It can also help prevent suicide in people who are likely to harm themselves. It also reduces aggression and the desire to hurt others. It can decrease negative thoughts and hallucinations.

Haloperidol can also be used to treat uncontrolled movements and outbursts of words/sounds related to Tourette's disorder. Haloperidol is also used for severe behavior problems in hyperactive children when other treatments or medications have not worked.

Haloperidol is a psychiatric medication (antipsychotic-type) that works by helping to restore the balance of certain natural substances in the brain (neurotransmitters).

Haloperidol is available under the following different brand names: Haldol, Haldol Decanoate, Haloperidol LA, and Peridol.

Dosage of Haloperidol:

Adult and Pediatric Dosage Forms and Strengths

Tablets

  • 0.5 mg
  • 1 mg
  • 2 mg
  • 5 mg
  • 10 mg
  • 20 mg

Oral concentrate

  • 2 mg/mL

Injectable solution, lactate

  • 5 mg/mL

Injectable solution, decanoate

  • 50 mg/mL

Dosing Consideraations – Should be Given as Follows:

Schizophrenia, Psychosis

Oral

  • Moderate disease, 0.5-2 mg every 8-12 hours initially
  • Severe disease, 3-5 mg every 8-12 hours initially; not to exceed 30 mg/day

Intramuscular (IM) lactate (prompt-acting)

  • 2-5 mg every 4-8 hours as needed; may require every hour in acute agitation; not to exceed 20 mg/day

Intramuscular (IM) decanoate (depot)

  • Initial: IM dose 10-20 times daily orally dose administered monthly; not to exceed 100 mg; if conversion requires initial dose greater than 100 mg, administer in 2 injections (e.g., 100 mg initially, then remainder in 3-7 days)
  • Maintenance: Monthly dose 10-15 times daily orally dose

Intravenous (IV) (Off-label)

  • May be needed for ICU delirium; use only haloperidol lactate for IV administration; do not use haloperidol decanoate
  • 2-10 mg initially, depending on degree of agitation; if response inadequate, may repeat bolus every 15-30 minutes, sequentially doubling initial bolus dose; when calm achieved, administer 25% of last bolus dose every 6 hours; taper dose after patient is controlled
  • Monitor ECG and QT interval (QT prolongation may occur with cumulative doses 35 mg or more; torsades de pointes reported with single doses 20 mg or more)

Pediatric

  • Children under 3 years: Safety and efficacy not established
  • 3-12 years (15-40 kg): 0.25-0.5 mg/day orally divided every 8-12 hours initially; may be increased by 0.5 mg/day every 5-7 days as needed; maintenance: 0.05-0.15 mg/kg/day orally divided every 8-12 hours
  • 6-12 years: Lactate (prompt-acting): 1-3 mg intramuscularly (IM) every 4-8 hours as needed; not to exceed 0.15 mg/kg/day
  • Children over 12 years: Moderate disease, 0.5-2 mg orally every 8-12 hours initially; severe disease, 3-5 mg orally every 8-12 hours; not to exceed 30 mg/day

Tourette Disorder

  • Adult: 0.5-2 mg orally every 8-12 hours initially; if severe symptoms necessitate increased dosage, titrate upward to 3-5 mg orally every 8-12 hours; if patient remains inadequately controlled, daily doses up to 100 mg have been used (safety not determined)
  • Children under 3 years: Safety and efficacy not established
  • Children 3-12 years: 0.5 mg/day orally initially; dose increased by 0.5 mg every 5-7 days until therapeutic effect achieved, then reduced to lowest effective maintenance level of 0.05-0.075 mg/kg/day orally divided every 8-12 hours
  • Children over 12 years: 0.5-2 mg orally every 8-12 hours initially; if severe symptoms necessitate increased dosage, titrate upward to 3-5 mg orally every 8-12 hours; if patient remains inadequately controlled, daily doses up to 100 mg have been used (safety not determined)

Behavioral Disorders, Pediatric

  • Children under 3 years: Safety and efficacy not established
  • Children 3-12 years: 0.5 mg/day orally initially; dose increased as needed by 0.5 mg every 5-7 days until therapeutic effect achieved, then reduced to lowest effective maintenance level of 0.05-0.075 mg/kg/day orally divided every 8-12 hours

Acute Agitation, Pediatric

  • Children under 12 years: Safety and efficacy not established
  • Children over 12 years: 0.5-3 mg orally, repeated in 1 hour as needed; alternatively, 2-5 mg intramuscularly (IM), repeated in 1 hour as needed

What Are Side Effects Associated with Using Haloperidol?

Common side effects of haloperidol include:

Less common side effects of haloperidol include:

Uncommon side effects of haloperidol include:

Rare side effects of haloperidol include:

Postmarketing side effects of haloperidol reported include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Haloperidol?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of haloperidol include:

  • amiodarone
  • astemizole
  • cisapride
  • disopyramide
  • eliglustat
  • flibanserin
  • ibutilide
  • indapamide
  • lomitapide
  • pentamidine
  • pimozide
  • procainamide
  • quinidine
  • sotalol
  • terfenadine

Haloperidol has serious interactions with at least 87 different drugs.

Haloperidol has moderate interactions with at least 336 different drugs.

Haloperidol has mild interactions with at least 42 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Haloperidol?

Warnings

Patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk for death, as shown in short-term controlled trials; deaths in trials appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature

Not approved for treatment of patients with dementia-related psychosis

This medication contains haloperidol. Do not take Haldol, Haldol Decanoate, Haloperidol LA, or Peridol if you are allergic to haloperidol or any ingredients contained in this drug

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

  • Documented hypersensitivity
  • Severe CNS depression (including coma), NMS, poorly controlled seizure disorder, Parkinson disease

Short-Term Effects

  • May cause central nervous system (CNS) depression; may impair ability to operate heavy machinery or driving
  • See "What Are Side Effects Associated with Using Haloperidol?"

Long-Term Effects

  • Cataracts (prolonged use)
  • Safety of prolonged administration of 100 mg/day orally not established
  • See "What Are Side Effects Associated with Using Haloperidol?"

Cautions

  • Risk of sudden death, torsades de pointes, and prolonged QT interval from off-label IV administration of higher than recommended dose: monitor ECG if administering intravenously (IV)
  • Conditions or drugs that prolong QT interval, congenital long QT syndrome
  • Safety of prolonged administration of 100 mg/day orally not established
  • Avoid use in narrow angle glaucoma, bone marrow suppression, and severe hypotension
  • FDA warning regarding off-label use for dementia in elderly
  • Leukopenia/neutropenia and agranulocytosis reported; possible risk factors include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia
  • If patient has history of clinically significant presence of either risk factor, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of clinically significant WBC decline less than 1000/µL in absence of other causative factors, and continue monitoring WBC count until recovery
  • Severe neurotoxicity manifesting as rigidity or inability to walk or talk may occur in patients with thyrotoxicosis also receiving antipsychotics
  • If administering intravenously or intramuscularly (IV or IM), watch for hypotension; use with caution in diagnosed CNS depression, subcortical brain damage, or cardiac disease; if history of seizures, benefits must outweigh risks; significant increase in body temperature may indicate intolerance to antipsychotics (discontinue if this occurs)
  • Use caution in patients at risk of pneumonia (e
  • g, Alzheimer's patients); antipsychotic use reported to be associated with esophageal dysmotility and aspiration
  • Extrapyramidal symptoms may occur including acute dystonic reactions, akathisia, tardive dyskinesia, and pseudoparkinsonism
  • Hyperprolactinemia may occur
  • Monitor for mental status changes, muscle rigidity, fever, and/or autonomic instability; neuroleptic malignant syndrome may occur
  • May cause orthostatic hypotension
  • Association with increased risk of pigmentary retinopathy reported
  • Impairment of core body temperature regulation reported; use caution with activities that may increase body temperature including strenuous exercise, heat exposure, dehydration, and concomitant medications with anticholinergic effects
  • Caution in patients receiving anticoagulants; isolated instance of interference occurred with effects of one anticoagulant (phenindione)
  • When used to control mania in cyclic disorders, there may be rapid mood swing to depression
  • May cause anticholinergic effects; use caution in patients with xerostomia, urinary retention, BPH, decreased gastrointestinal motility, paralytic ileus, or visual problems
  • May cause central nervous system (CNS) depression; may impair ability to operate heavy machinery or driving
  • Decreased sensation of thirst due to central inhibition may lead to dehydration, hemoconcentration and reduced pulmonary ventilation; a number of cases of bronchopneumonia, some fatal, reported; if signs and symptoms appear, especially in the elderly, institute remedial therapy promptly
  • Use caution in patients with severe cardiovascular disorders, because of possibility of transient hypotension and/or precipitation of anginal pain; should hypotension occur and a vasopressor be required, epinephrine should not be used since haloperidol may block its vasopressor activity and paradoxical further lowering of the blood pressure may occur; use metaraminol, phenylephrine or norepinephrine instead
  • Use caution in patients receiving anticonvulsant medications, with a history of seizures, or with EEG abnormalities; haloperidol may lower convulsive threshold; if indicated, adequate anticonvulsant therapy should be concomitantly maintained

Pregnancy and Lactation

  • Use haloperidol with caution during pregnancy if benefits outweigh risks
  • Animal studies show risk and human studies are not available, or neither animal nor human studies were done
  • Neonates exposed to antipsychotic drugs such as haloperidol during 3rd trimester of pregnancy are at risk for extrapyramidal or withdrawal symptoms after delivery; these complications vary in severity, in some cases being self-limited and in other cases necessitating ICU support and prolonged hospitalization
  • Haloperidol enters breast milk; it is not recommended for use while breastfeeding
Reviewed on 6/2/2017

Medscape. Haloperidol.
https://reference.medscape.com/drug/haldol-decanoate-haloperidol-342974

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