From the Guidelines
Haloperidol should be used with caution and at the lowest effective dose, particularly in elderly patients or those with cardiac conditions, due to the risk of extrapyramidal symptoms, QT interval prolongation, and torsades de pointes 1.
Introduction to Haloperidol
Haloperidol is a first-generation antipsychotic medication primarily used to treat schizophrenia, acute psychosis, delirium, and severe agitation.
Dosage and Administration
The typical starting dose for adults with acute psychosis is 0.5-1 mg orally at night and every 2 hours when required, with a maximum dose of 10 mg daily, or 5 mg daily in elderly patients 1. In emergency situations, haloperidol can be administered intramuscularly at 2-5 mg, repeated every 4-8 hours as needed.
Mechanism of Action and Side Effects
Haloperidol works by blocking dopamine D2 receptors in the brain, which helps reduce hallucinations, delusions, and disorganized thinking. Common side effects include:
- Extrapyramidal symptoms (muscle stiffness, tremor, restlessness)
- Sedation
- QT interval prolongation Regular monitoring for these effects is essential, particularly during initial treatment. Long-term use requires monitoring for tardive dyskinesia, a potentially irreversible movement disorder.
Special Considerations
Haloperidol should be used cautiously in patients with:
- Cardiac conditions
- Seizure disorders
- Parkinson's disease When discontinuing, the medication should be tapered gradually to avoid withdrawal symptoms or rebound psychosis. Additionally, haloperidol should be withheld in patients at high risk for torsades de pointes, such as those with baseline prolongation of QT interval or receiving concomitant medications known to prolong the QT interval 1.
From the FDA Drug Label
Haloperidol decanoate injection, 50 mg (base)/mL and haloperidol decanoate injection, 100 mg (base)/mL are indicated for the treatment of patients with schizophrenia who require prolonged parenteral antipsychotic therapy. Haloperidol tablets are indicated for use in the management of manifestations of psychotic disorders.
The indications for Haloperidol are:
- Treatment of patients with schizophrenia who require prolonged parenteral antipsychotic therapy 2
- Management of manifestations of psychotic disorders 3
- Control of tics and vocal utterances of Tourette’s Disorder in children and adults 3
- Treatment of severe behavior problems in children 3
- Short-term treatment of hyperactive children with accompanying conduct disorders 3
From the Research
Haloperidol Overview
- Haloperidol is a benchmark antipsychotic drug used to treat people with schizophrenia and other psychotic disorders 4, 5, 6.
- It is a dopamine receptor antagonist that can cause extrapyramidal symptoms (EPS), especially at high doses 7.
Efficacy of Haloperidol
- Studies have shown that haloperidol is effective in treating acute schizophrenia, with more people allocated to haloperidol improving in the first six weeks of treatment compared to those given placebo 6.
- Haloperidol has been found to be more effective than some second-generation antipsychotics, such as aripiprazole, quetiapine, and ziprasidone, in treating acutely ill patients with schizophrenia 8.
- However, haloperidol has a higher risk of EPS compared to second-generation antipsychotics 6, 7.
Dosage and Side Effects
- The optimal dose range for haloperidol in the treatment of acute schizophrenia is not well established, but doses between 3-7.5 mg/day may be effective with fewer side effects 4, 5.
- Higher doses of haloperidol (>7.5 mg/day) may increase the risk of EPS, such as acute dystonia, akathisia, and parkinsonism 4, 5, 6, 7.
- Smoking haloperidol can lead to acute EPS, such as dystonia, and clinicians should be aware of the potential for misuse of prescribed antipsychotics via unconventional routes 7.