Is Haloperidol on the Beers List?
Yes, haloperidol is explicitly included on the American Geriatrics Society Beers Criteria as a potentially inappropriate medication for older adults, particularly for long-term use in managing cognitive behavioral problems. 1
Specific Beers Criteria Classification
Haloperidol appears in the Beers Criteria under the category of antipsychotics that should be avoided for behavioral management in older adults, especially those with dementia. 1
Key Restrictions and Warnings
- Long-term use of haloperidol for cognitive behavioral problems should be avoided in older adults 1
- The medication carries a strong recommendation that harms clearly outweigh benefits except in specific circumstances 2
- Haloperidol is associated with increased mortality risk when used for dementing disorders, which is reflected in an FDA black box warning 1
Acceptable Use Scenarios
The Beers Criteria does permit haloperidol use in limited, specific situations: 1
- Short-term use during chemotherapy as an antiemetic 1
- Treatment of schizophrenia 1
- Management of acute delirium in controlled settings 1
These exceptions do not apply to the common practice of using haloperidol for behavioral control in dementia or general agitation in older adults.
Documented Risks in Older Adults
The rationale for including haloperidol on the Beers list includes: 1
- Increased mortality in persons with dementia 1
- Delirium induction or worsening 1
- Falls and fractures due to sedation and motor impairment 1
- Cerebrovascular accidents (stroke) 1
- Cognitive impairment and slowed comprehension 1
- Movement disorders and extrapyramidal symptoms 1
Clinical Application
Deprescribing haloperidol is recommended when it is being used for behavioral management, especially when there is perceived lack of benefit. 1 The medication can be safely tapered to discontinuation in most cases. 1
Preferred Alternatives
- Non-pharmacological approaches should be considered first-line for behavioral symptoms, including redirection techniques and environmental modifications 1
- If antipsychotic use is unavoidable, the shortest possible duration should be employed 1
- Regular medication review using STOPP/START or Beers Criteria is essential to identify opportunities for deprescribing 1, 3
Common Pitfall
The most frequent misuse occurs when haloperidol is prescribed "as needed" (PRN) for agitation in hospitalized elderly patients—this practice was documented in 18% of very old hospitalized patients despite Beers Criteria recommendations against it. 4 This PRN prescribing pattern increases the risk of adverse effects while adding to the polypharmacy burden common in this population. 4