Proper Dosage and Usage of Haloperidol (Haldol)
Haloperidol dosage should be individualized according to the patient's condition, with initial doses of 0.5-2 mg 2-3 times daily for moderate symptoms and 3-5 mg 2-3 times daily for severe symptoms, with careful titration to minimize side effects. 1
Dosage Guidelines by Patient Population
Adults
- For moderate symptoms: 0.5-2 mg 2-3 times daily 1
- For severe symptoms: 3-5 mg 2-3 times daily 1
- For chronic or resistant patients: 3-5 mg 2-3 times daily, with potential increases up to 100 mg daily in severe cases 1
Special Populations
- Geriatric or debilitated patients: Start with 0.5-2 mg 2-3 times daily 1
- Children (3-12 years, 15-40 kg):
Clinical Applications
Delirium Management
- For delirium: 0.5-2 mg PO or SC, with PRN dosing of 0.5-1 mg every hour as needed 2
- For scheduled dosing: Administer every 8-12 hours 2
- Use lower doses (0.25-0.5 mg) in older or frail patients and titrate gradually 2
- Avoid in patients with Parkinson's disease or Lewy body dementia due to risk of extrapyramidal symptoms 2
Nausea Control
- For nausea in cancer patients: 0.5-1 mg PO every 6-8 hours 2
- Consider scheduled administration if nausea persists despite as-needed regimen 2
Acute Agitation
- For emergency sedation of disruptive patients: IM, IV, or oral administration with efficacy in 83% of patients within 30 minutes 3
- May be more effective than benzodiazepines for sedation beyond 5 minutes in acute agitation 2
Administration Routes
- Oral (PO): First-line for non-emergent situations 1
- Subcutaneous (SC): Alternative for patients unable to take oral medication 2
- Intramuscular (IM): For rapid control in emergency situations 3
- Intravenous (IV): Requires ECG monitoring due to QTc prolongation risk 2
Side Effect Management
Common Side Effects
- Extrapyramidal symptoms (EPS): Tremor, rigidity, shuffling gait 4, 5
- QTc prolongation: Monitor ECG, especially with IV administration 2, 6
- Sedation: May require dose adjustment 2
Managing Extrapyramidal Symptoms
- For shuffling gait or other EPS: Consider switching to atypical antipsychotics like risperidone, olanzapine, or quetiapine 4
- If switching is not immediately possible, decrease haloperidol dose while monitoring for return of psychotic symptoms 4
- Monitor regularly for worsening EPS as they can progress to irreversible tardive dyskinesia 4
Important Precautions
- Perform ECG monitoring when administering IV haloperidol due to risk of QTc prolongation 2, 6
- Haloperidol can induce oxidative stress leading to neurotoxicity and cardiotoxicity 6
- Avoid concomitant use with other QTc-prolonging medications 2
- Monitor for hypotension, especially in critically ill patients 3
Maintenance Therapy
- Upon achieving satisfactory therapeutic response, gradually reduce to lowest effective maintenance level 1
- When switching from injectable to oral form, use the 24-hour parenteral dose as initial estimate for total daily oral dose 1
- Monitor clinical signs, symptoms, efficacy, sedation, and adverse effects during the first several days after switching 1
Common Pitfalls to Avoid
- Avoid using haloperidol in patients with Parkinson's disease or Lewy body dementia 2
- Don't misattribute all gait disturbances to medication effects; consider other neurological causes 4
- Avoid polypharmacy by adding medications to treat side effects rather than addressing the primary cause 4
- Continue monitoring for both resolution of side effects and control of original symptoms after medication changes 4