From the Guidelines
Haloperidol is contraindicated in patients at high risk for torsades de pointes, including those with baseline prolongation of QT interval, patients receiving concomitant medications known to prolong the QT interval, or patients with a history of this arrhythmia. This is based on the recommendation from the clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit 1. The guidelines suggest withholding haloperidol and atypical antipsychotics in these patients due to the high risk of morbidity and mortality associated with torsades de pointes.
Some of the key conditions that increase the risk of torsades de pointes and are therefore contraindications for haloperidol include:
- Baseline prolongation of QT interval
- Patients receiving concomitant medications known to prolong the QT interval
- Patients with a history of torsades de pointes Other contraindications for haloperidol may include:
- Severe central nervous system depression
- Comatose states
- Severe liver or cardiac disease
- Pregnancy, especially in the first trimester
- Hypersensitivity to haloperidol or any component of its formulation
- Parkinson's disease or Lewy body dementia
- Elderly patients with dementia-related psychosis due to increased mortality risk
- Patients with seizure disorders or hypothyroidism
- Patients with a history of neuroleptic malignant syndrome
The decision to use haloperidol should be made with caution, considering the potential risks and benefits, and alternative treatments should be explored in patients with these contraindications 1.
From the FDA Drug Label
Haloperidol tablets are contraindicated in severe toxic central nervous system depression or comatose states from any cause and in individuals who are hypersensitive to this drug or have Parkinson’s disease. The contraindications for haloperidol are:
- Severe toxic central nervous system depression
- Comatose states from any cause
- Hypersensitivity to the drug
- Parkinson’s disease 2
From the Research
Contraindications for Haloperidol
The following are some contraindications for haloperidol:
- Prolongation of the QT interval, which can lead to torsade de pointes and death 3, 4, 5
- Extrapyramidal symptoms, such as parkinsonism, dystonia, and akathisia 3, 6, 7
- Neuroleptic malignant syndrome, a rare but life-threatening condition 4
- Catatonia, a condition characterized by immobility, mutism, and unresponsiveness 4
- Patients with a history of seizures or epilepsy, as haloperidol can lower the seizure threshold 4
- Patients with a history of cardiovascular disease, as haloperidol can cause orthostatic hypotension and QT prolongation 4, 5
Special Considerations
Some patients may require special consideration when taking haloperidol, including:
- Patients with Parkinson's disease, as haloperidol can exacerbate motor symptoms 6
- Patients with dementia, as haloperidol can increase the risk of mortality and cognitive decline 4
- Patients with renal or hepatic impairment, as haloperidol can accumulate in the body and increase the risk of side effects 4
- Patients taking other medications that can interact with haloperidol, such as anticholinergics, beta blockers, and certain antibiotics 4