Haloperidol

1. Introduction

Haloperidol is a typical antipsychotic medication from the butyrophenone class. It is primarily used to manage schizophrenia, acute psychosis, and agitation, and to control tics in Tourette syndrome. It works by blocking dopamine (D2) receptors in the brain, reducing symptoms of psychosis.

2. Indications

  • Approved Indications:
    • Schizophrenia and other psychotic disorders.
    • Acute psychosis or agitation.
    • Tourette syndrome (control of severe tics and vocal utterances).
    • Delirium (short-term use in severe cases).
    • Mania in bipolar disorder (adjunctive therapy).
    • Nausea and vomiting (resistant cases).
  • Off-Label Uses:
    • Agitation in dementia (short-term use).
    • Huntington’s disease (to manage chorea).

3. Dosage

  • Adults:
    • Schizophrenia/Psychosis:
      • Oral: 0.5–5 mg two or three times daily (maximum: 20 mg/day).
      • IM (acute agitation): 2–10 mg, repeated every 4–8 hours as needed (maximum: 18 mg/day).
    • Tourette Syndrome:
      • Oral: 0.5–3 mg twice daily (maximum: 10 mg/day).
  • Elderly:
    • Start with 0.25–0.5 mg twice daily and titrate slowly due to increased sensitivity to side effects.
  • Children (≥3 years):
    • Tourette Syndrome/Severe Behavioural Disorders:
      • Oral: 0.25–0.5 mg daily, increased as needed (maximum: 0.15 mg/kg/day).

4. Administration

  • Oral: Take with or without food. Use with water if taking liquid formulations.
  • Intramuscular: Administer deep IM; avoid IV administration unless closely monitored due to cardiovascular risks.
  • Do not abruptly discontinue; taper gradually to prevent withdrawal symptoms.

5. Forms Available

  • Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg.
  • Oral solution: 2 mg/mL.
  • Injectable solution (IM): 5 mg/mL.
  • Long-acting injectable (depot): 50 mg/mL, 100 mg/mL (decanoate formulation).

6. Side Effects

6.1. Common Side Effects

  • Extrapyramidal symptoms (e.g., tremors, rigidity, bradykinesia).
  • Drowsiness or sedation.
  • Dry mouth.
  • Constipation.

6.2. Less Common Side Effects

  • Weight gain.
  • Blurred vision.
  • Orthostatic hypotension.

6.3. Rare but Serious Side Effects

  • Neuroleptic malignant syndrome (NMS).
  • Tardive dyskinesia (involuntary, repetitive movements).
  • QT prolongation and cardiac arrhythmias.

7. Warnings

  • Neuroleptic Malignant Syndrome: Rare but life-threatening; symptoms include fever, muscle rigidity, altered mental status, and autonomic dysfunction.
  • QT Prolongation: Risk of torsades de pointes; use cautiously in patients with cardiac conditions or electrolyte imbalances.
  • Elderly Patients with Dementia-Related Psychosis: Increased mortality risk; not recommended for this population.

8. Precautions

  • Use cautiously in patients with:
    • Parkinson’s disease (may worsen symptoms).
    • Liver dysfunction (metabolised in the liver).
    • Seizure disorders (lowers seizure threshold).
  • Regularly monitor for extrapyramidal side effects and tardive dyskinesia during long-term use.

9. Interactions

  • Drug-Drug Interactions:
    • CNS depressants (e.g., benzodiazepines, opioids): Increased sedation.
    • Anticholinergic drugs: Increased risk of constipation, urinary retention, and confusion.
    • QT-prolonging agents (e.g., amiodarone, quinidine): Additive risk of cardiac arrhythmias.
  • Drug-Food Interactions:
    • Avoid alcohol, as it may enhance CNS depression.

10. Monitoring Parameters

  • Symptoms of psychosis or tics (for improvement).
  • Signs of extrapyramidal symptoms or tardive dyskinesia.
  • ECG for QT prolongation in high-risk patients or those on high doses.
  • Liver function tests during prolonged therapy.

11. Use in Children

  • Approved for use in children aged ≥3 years for severe behavioural disorders or Tourette syndrome. Use the lowest effective dose and monitor closely for side effects.

12. Use in Pregnancy

  • Category C: Use only if the potential benefit outweighs the risks. Neonates exposed during the third trimester may show withdrawal symptoms or extrapyramidal side effects.

13. Use in Elderly

  • Start with lower doses and titrate slowly. Avoid use in elderly patients with dementia-related psychosis due to increased mortality risk.

14. Use in Kidney Disease

  • No specific dose adjustment is required, but monitor for side effects due to potential accumulation.

15. Use in Liver Disease

  • Use cautiously in patients with hepatic impairment. Monitor liver function regularly, as haloperidol is metabolised in the liver.

16. Patient Counselling Points

  • Take haloperidol as prescribed; do not stop abruptly without consulting your doctor.
  • Report any unusual movements, muscle stiffness, fever, or severe drowsiness immediately.
  • Avoid alcohol and other sedatives while on haloperidol.
  • Be cautious while driving or operating heavy machinery, as the medication may cause drowsiness.
  • For injectable formulations, ensure regular follow-ups for dose adjustments and monitoring.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
HaldolJanssen Pharmaceuticals$20–40 (30 tablets, 5 mg)
Haloperidol DecanoateJanssen Pharmaceuticals$50–100 (50 mg/mL)
Generic HaloperidolVarious manufacturers$10–30 (30 tablets, 5 mg)

18. FAQs (15 Questions)

  1. What is haloperidol used for?
    Haloperidol is used to treat schizophrenia, psychosis, Tourette syndrome, and agitation.
  2. How does haloperidol work?
    It blocks dopamine receptors in the brain, reducing symptoms of psychosis and agitation.
  3. How long does haloperidol take to work?
    Effects on agitation can occur within hours, while improvement in psychotic symptoms may take days to weeks.
  4. Can haloperidol cause drowsiness?
    Yes, drowsiness is a common side effect.
  5. What are extrapyramidal symptoms?
    They include tremors, muscle rigidity, and involuntary movements caused by dopamine blockade.
  6. Can haloperidol cause weight gain?
    Yes, weight gain can occur but is less common compared to atypical antipsychotics.
  7. Is haloperidol safe during pregnancy?
    Use only if necessary; consult your doctor for risks and benefits.
  8. Can I drink alcohol while taking haloperidol?
    No, alcohol may increase drowsiness and other side effects.
  9. How should haloperidol be taken?
    Take it as prescribed, with or without food.
  10. What should I do if I miss a dose?
    Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up.
  11. Does haloperidol interact with other medications?
    Yes, it interacts with CNS depressants, QT-prolonging drugs, and anticholinergics.
  12. Can haloperidol be stopped abruptly?
    No, stopping suddenly may cause withdrawal symptoms. Taper the dose under medical supervision.
  13. How is haloperidol stored?
    Store at room temperature, away from moisture and light.
  14. What is tardive dyskinesia?
    A condition causing involuntary movements, often associated with long-term antipsychotic use.
  15. Can haloperidol be used for anxiety?
    It is not typically used for anxiety unless associated with psychosis or severe agitation.
  16. Meta Tag for Haloperidol