What are the contraindications for Haldol (haloperidol)?

From the Guidelines

Haloperidol (Haldol) should not be used in patients with certain conditions due to increased risk of morbidity and mortality, including those with Parkinson's disease, Lewy body dementia, or a history of neuroleptic malignant syndrome. The contraindications for Haldol include known hypersensitivity to the medication, severe central nervous system depression, or comatose states.

• Patients with QT prolongation or conditions that may increase the risk of QT prolongation, such as congenital long QT syndrome, recent acute myocardial infarction, uncompensated heart failure, or cardiac arrhythmias, should avoid Haldol 1.
• The medication should not be used in combination with medications that significantly prolong the QT interval.
• Caution is warranted in elderly patients with dementia-related psychosis due to increased mortality risk, as noted in various guidelines 1.
• Haloperidol crosses the placental barrier, so risks and benefits should be carefully weighed during pregnancy.
• The medication is also present in breast milk, requiring careful consideration for nursing mothers.
• Other conditions that may require caution or avoidance of Haldol include severe renal or hepatic impairment, as well as patients with a history of torsades de pointes or other arrhythmias 1.
• It is essential to consider the potential side effects of Haldol, including extrapyramidal symptoms, tardive dyskinesia, and orthostatic hypotension, when deciding to use this medication, especially in vulnerable populations such as the elderly or those with underlying medical conditions 1.

From the FDA Drug Label

Haloperidol is contraindicated in severe toxic central nervous system depression or comatose states from any cause and in individuals who are hypersensitive to this drug or have Parkinson's disease. The contraindications for Haldol (haloperidol) are:

• Severe toxic central nervous system depression
• Comatose states from any cause
• Hypersensitivity to the drug
• Parkinson's disease 2 3

From the Research

Haldol Contraindications

• Haldol, also known as haloperidol, has several contraindications due to its potential to cause QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death 4, 5, 6, 7.
• Patients with a history of QTc-prolongation, Torsade de Pointes, or other cardiac conditions should avoid using Haldol 5, 6, 7.
• The use of Haldol in combination with other drugs that prolong the QTc interval, such as amiodarone, should be avoided 5, 6.
• Patients with hypokalemia, a condition characterized by low potassium levels, should not use Haldol as it can increase the risk of QTc-prolongation 5, 6.
• Old age and heart failure are also risk factors for QTc-prolongation and should be considered when prescribing Haldol 5, 6.
• It is essential to monitor patients' electrocardiograms before and during Haldol treatment, especially those with a high risk of QTc-prolongation 4, 5, 7.

Special Considerations

• Intravenous haloperidol may be more likely to cause QTc-prolongation than oral administration, especially in medically ill populations 6, 7.
• The risk of QTc-prolongation associated with Haldol may be dose-dependent, and lower doses may be safer 8.
• Patients with Parkinson's disease may require special consideration when using Haldol, as low-dose haloperidol may increase dopamine receptor sensitivity and clinical response 8.