What is the proper dosage and administration of Haldol (haloperidol) for treating acute psychosis or agitation?

From the Guidelines

Haloperidol (Haldol) for acute psychosis or agitation should be administered at an initial dose of 0.5-1 mg orally or subcutaneously, with the option to increase the dose in 0.5-1 mg increments as required, up to a maximum of 10 mg daily, or 5 mg daily in elderly patients, as recommended by the most recent and highest quality study 1. The dosage and administration of Haldol for treating acute psychosis or agitation can vary depending on the patient's condition and response to the medication.

• The initial dose can be repeated every 2 hours as needed, with the option to administer the same dose subcutaneously instead of orally, or as a subcutaneous infusion of 2.5-10 mg over 24 hours 1.
• For patients who are severely distressed or causing immediate danger to others, a higher starting oral dose of 1.5-3 mg may be considered 1.
• Additionally, a benzodiazepine such as lorazepam or midazolam may be added if the patient remains agitated, as suggested by the guidelines 1. It is essential to monitor the patient's response to the medication and adjust the dosage accordingly to minimize the risk of adverse effects, such as extrapyramidal symptoms and QT prolongation, which can be a serious concern, especially with higher doses or in patients with cardiac risk factors 1.
• The medication should be tapered gradually when discontinuing to avoid withdrawal symptoms or rebound psychosis.
• It is also crucial to consider the potential risks and benefits of using Haldol, particularly in elderly patients or those with hepatic impairment, and to carefully monitor their response to the medication.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION There is considerable variation from patient to patient in the amount of medication required for treatment. As with all antipsychotic drugs, dosage should be individualized according to the needs and response of each patient. Clinical experience suggests the following recommendations: Initial Dosage Range Adults Moderate Symptomatology 0.5 mg to 2.0 mg b.i.d. or t.i.d. Severe Symptomatology 3.0 mg to 5.0 mg b.i.d. or t.i. d. To achieve prompt control, higher doses may be required in some cases Geriatric or Debilitated Patients 0.5 mg to 2.0 mg b.i.d. or t.i.d. Chronic or Resistant Patients 3.0 mg to 5.0 mg b.i.d. or t.i. d. Patients who remain severely disturbed or inadequately controlled may require dosage adjustment. Daily dosages up to 100 mg may be necessary in some cases to achieve an optimal response.

The proper dosage and administration of Haldol (haloperidol) for treating acute psychosis or agitation is as follows:

• Initial Dosage Range:
  • Adults: 0.5 mg to 2.0 mg b.i.d. or t.i.d. for moderate symptomatology, and 3.0 mg to 5.0 mg b.i.d. or t.i.d. for severe symptomatology.
  • Geriatric or Debilitated Patients: 0.5 mg to 2.0 mg b.i.d. or t.i.d.
• Dosage Adjustment: Patients who remain severely disturbed or inadequately controlled may require dosage adjustment, up to 100 mg per day. 2

From the Research

Dosage and Administration of Haldol

The proper dosage and administration of Haldol (haloperidol) for treating acute psychosis or agitation can vary depending on the individual and the specific circumstances.

• According to a study published in 2017 3, haloperidol is recommended to help calm situations of aggression or agitation for people with psychosis, and it is widely accessible.
• The study found that compared with placebo, more people in the haloperidol group were asleep at two hours, and experienced dystonia.
• Another study published in 1999 4 found that optimal doses of haloperidol for the treatment of a first episode of psychosis were 2 mg daily for 15 subjects, 5 mg daily for 11,10 mg daily for 7, and 20 mg daily for 3.
• The study also found that many people suffering a first psychotic episode respond to haloperidol doses well below levels in common use.

Side Effects and Risks

Haldol can cause side effects, including extrapyramidal symptoms (EPS) such as dystonia, and tardive dyskinesia.

• A study published in 2003 5 found that the 12-month incidence of tardive dyskinesia in subjects with first-episode psychosis who were treated with very low doses of haloperidol was 12.3%.
• The study also found that subjects with tardive dyskinesia were older and received higher mean doses of haloperidol at 12 months.
• Another study published in 1994 6 found that negative symptoms responsive to treatment with haloperidol were affective flattening and alogia, and improvement in negative symptoms was independent from that in positive ones.

Administration Routes

Haldol can be administered via different routes, including oral and intramuscular.

• A study published in 2017 3 found that sole use of intramuscular haloperidol could be life-saving in emergency situations.
• However, the study also found that adding a benzodiazepine to haloperidol does not have strong evidence of benefit and carries risk of additional harm.
• A case report published in 2021 7 described a patient who smoked marijuana mixed with crushed haloperidol tablets, highlighting the potential for misuse of the medication via unconventional routes.