Haloperidol IV Dosing and Administration
For acute agitation in adults, administer haloperidol 2-5 mg IV initially, with subsequent doses every 4-8 hours as needed, not exceeding 20 mg per day. 1
Standard IV Dosing Protocol
Initial Dose for Acute Agitation
- Adults: 2-5 mg IV for prompt control of moderately severe to very severe symptoms 1
- Older adults (≥65 years): Start with 0.5-1 mg IV, as lower doses demonstrate similar efficacy with better safety outcomes 2
- Pediatric patients: 0.05-0.15 mg/kg IV/IM (maximum 5 mg per dose), may repeat hourly as needed 3, 4
Repeat Dosing Strategy
- Subsequent doses may be administered as often as every hour if needed 1
- More commonly, 4-8 hour intervals are satisfactory for most patients 1
- For severe agitation in adults, doses can be repeated every 20-30 minutes until controlled, not exceeding 40 mg daily maximum 4
Maximum Daily Limits
- FDA-approved maximum: 20 mg per day via parenteral route 1
- Guideline recommendations: Up to 40 mg per day for severe agitation in adults and adolescents 4
- Geriatric/frail patients: Maximum 10 mg daily, using 0.25-0.5 mg doses 4
Administration Technique
Preparation and Monitoring
- Inspect solution visually for particulate matter and discoloration before administration 1
- Monitor vital signs continuously, especially with repeated doses 4
- Obtain baseline ECG if using doses >2 mg or in patients with cardiac risk factors 5
Pharmacokinetic Profile
Special Populations and Dose Adjustments
Debilitated or Geriatric Patients
- Require less haloperidol with more gradual dosage adjustments 1
- Evidence supports 0.5 mg as an effective initial dose with fewer adverse effects than higher doses 2
- Lower doses (0.5-1 mg) associated with shorter length of stay and reduced restraint use 2
Critically Ill Patients
- For refractory severe agitation, continuous infusions of 3-25 mg/hour have been used 4, 6
- Average effective dose in ICU settings: 269 mg daily via continuous infusion for severe refractory agitation 6
- However, prophylactic haloperidol does not improve survival in critically ill patients and is not recommended for this indication 7
Transition to Oral Therapy
Switchover Protocol
- Begin oral dosing within 12-24 hours following the last parenteral dose 1
- Use the total parenteral dose administered in the preceding 24 hours as an initial approximation for oral dosing 1
- Monitor clinical signs, efficacy, sedation, and adverse effects closely for the first several days 1
Critical Safety Warnings
Cardiovascular Monitoring
- QT prolongation risk increases with doses above 7.5 mg/day 4
- Avoid in patients already on QT-prolonging medications without cardiology consultation 5
- Monitor ECG with repeated dosing, particularly in cardiac patients 5
Extrapyramidal Symptoms
- Common with haloperidol and may require dose reduction 4
- Monitor for dystonic reactions, tremors, and other movement disorders 3, 4
- If extrapyramidal effects occur, reduce the next dose 4
Documented Adverse Events
- Minor tremors, atrial dysrhythmias with AV block, QT prolongation, and ventricular tachycardia reported with continuous infusions 6
- Hypotension and dystonic reactions may occur with standard dosing 3
Common Clinical Pitfalls
Avoid Excessive Dosing
- Doses exceeding 7.5 mg/day show no additional efficacy but significantly increase extrapyramidal adverse effects 8
- The standard lower dose range (3-7.5 mg/day) is as effective as higher doses with better tolerability 8
Not for Prophylaxis
- Do not use haloperidol prophylactically in critically ill patients to prevent delirium—it does not improve survival or reduce delirium incidence 7