What dose of Haldol (haloperidol) to give?

From the Guidelines

The recommended starting dose of Haloperidol (Haldol) is 0.5–1 mg p.o. or s.c. stat, with a PRN dose of 0.5 or 1 mg p.o. or s.c. q1h PRN, as suggested by the most recent guidelines 1. When considering the management of delirium symptoms in adult patients, it is crucial to weigh the potential benefits and risks of pharmacological interventions.

• The suggested starting dose of Haloperidol can be adjusted based on the patient's response and tolerance, with a maximum dose not explicitly stated in the guidelines 1.
• However, it is essential to use lower doses in older or frail patients, e.g., 0.25–0.5 mg, and titrate gradually to minimize the risk of adverse effects 1.
• The guidelines also recommend avoiding the use of Haloperidol in patients with Parkinson’s disease or dementia with Lewy bodies due to the risk of extrapyramidal symptoms (EPSEs) 1.
• Additionally, Haloperidol may prolong the QTc interval, and caution should be exercised when administering the medication, especially in patients with a history of cardiac conditions 1.
• In terms of administration, Haloperidol can be given orally, subcutaneously, intravenously, or intramuscularly, with the choice of route depending on the patient's specific needs and clinical circumstances 1.

From the FDA Drug Label

The dose of haloperidol decanoate injection, 50 mg (base)/mL or haloperidol decanoate injection, 100 mg (base)/mL should be expressed in terms of its haloperidol, USP content. The starting dose of haloperidol decanoate, USP should be based on the patient's age, clinical history, physical condition, and response to previous antipsychotic therapy For patients previously maintained on low doses of antipsychotics (e. g. up to the equivalent of 10 mg/day oral haloperidol), it is recommended that the initial dose of haloperidol decanoate, USP be 10-15 times the previous daily dose in oral haloperidol equivalents; The initial dose of haloperidol decanoate, USP should not exceed 100 mg regardless of previous antipsychotic dose requirements.

The dose of Haldol (haloperidol) to give is:

• 10-15 times the previous daily dose in oral haloperidol equivalents for patients previously maintained on low doses of antipsychotics
• 20 times the previous daily dose in oral haloperidol equivalents for patients previously maintained on higher doses of antipsychotics
• Not to exceed 100 mg as an initial dose, with downward titration on succeeding injections 2
• The maintenance dosage must be individualized with titration upward or downward based on therapeutic response, with a usual maintenance range of 10 to 15 times the previous daily dose in oral haloperidol equivalents.

From the Research

Dosing Recommendations for Haldol (Haloperidol)

The recommended dose of Haldol (haloperidol) varies depending on the patient population and the specific condition being treated.

• For older hospitalized patients with agitation and/or delirium, a low dose of haloperidol (≤0.5 mg) is recommended as an initial dose, as it has been shown to be similar in effect to higher doses 3.
• In patients with first-episode psychosis, optimal doses of haloperidol were found to be 2 mg daily for 15 subjects, 5 mg daily for 11,10 mg daily for 7, and 20 mg daily for 3, with many patients responding to doses well below common use 4.
• For agitated hospitalized older people with delirium, low-dose haloperidol appears to be as effective as and safer than higher doses, with a recommended starting dose of 0.5 mg 5.
• In clinical practice, the mean daily doses of haloperidol used in outpatients with schizophrenia were 13.9 mg initially and 13.6 mg overall, with a median daily dose of 10 mg 6.
• A method to individualize the dose of haloperidol to achieve a desired steady-state level in plasma from an observed drug level 24 hours after a single test dose has been reported, allowing for more precise dosing 7.

Key Considerations

• The evidence suggests that lower doses of haloperidol may be effective and safer in certain patient populations, such as older adults with agitation and/or delirium.
• The optimal dose of haloperidol may vary depending on the individual patient and the specific condition being treated.
• A test dose of haloperidol can be used to predict the maintenance dose required to achieve a targeted steady-state level in plasma.