Which antipsychotic medications have FDA‑approved intravenous formulations?

Antipsychotics Available IV

Based on current clinical practice guidelines, only two antipsychotics have documented intravenous formulations: haloperidol and chlorpromazine 1.

Available IV Antipsychotics

First-Generation Antipsychotics

• Haloperidol: Can be given IV with ECG monitoring required 1

  • Starting dose: 0.5–1 mg IV
  • May prolong QTc interval
  • Requires cardiac monitoring during IV administration
  • Risk of extrapyramidal symptoms (EPSEs)

• Chlorpromazine: Can be given as slow IV (diluted) or IV infusion 1

  • Starting dose: 12.5–25 mg
  • Sedating with anticholinergic effects
  • May cause orthostatic hypotension and prolong QTc interval
  • Parenteral use may cause local irritation

Second-Generation Antipsychotics

None of the second-generation antipsychotics have FDA-approved IV formulations. The evidence shows:

• Olanzapine: Available only as IM or subcutaneous, NOT IV 1
• Ziprasidone: Available only as IM, NOT IV 2
• Aripiprazole: Available only as IM, NOT IV 1

Important Clinical Caveats

Droperidol (a butyrophenone related to haloperidol) can be given IV and was historically used for acute agitation 2. However, it carries an FDA black box warning for QTc prolongation and dysrhythmias, making its use problematic despite evidence suggesting reasonable safety in large patient series 2.

The 2018 ESMO guidelines 1 and 2006 emergency department guidelines 2 consistently document that most modern antipsychotics are limited to oral, IM, or subcutaneous routes—IV formulations remain restricted to the older first-generation agents haloperidol and chlorpromazine.