Haloperidol
HALDOL
What it isHigh-potency D2/D3-antagonist antipsychotic; psychosis, delirium-related agitation, and Tourette syndrome.
Why this oneMinimal anticholinergic and metabolic burden, available IM and IV, and long familiarity in acute settings.
What limits itThe highest extrapyramidal and tardive dyskinesia risk of the common agents. QT prolongation, especially IV.
FDA-approved for
- schizophrenia (1967)
- Tourette syndrome (~1978)
Off-label
- delirium
- acute agitation
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Psychotic disorders | Adults | Moderate: 0.5-2 mg BID-TID; severe: 3-5 mg BID-TID | Titrate to response; up to 100 mg/day if needed | Doses >100 mg not established as safe |
| Psychotic disorders | Geriatric/debilitated or chronic/resistant | 0.5-2 mg BID-TID (geriatric/debilitated); 3-5 mg BID-TID (chronic/resistant) | Lowest effective maintenance | |
| Psychotic disorders, nonpsychotic behavior disorders, Tourette's | Children 3-12 yr (15-40 kg) | 0.5 mg/day | Psychotic 0.05-0.15 mg/kg/day; nonpsychotic & Tourette's 0.05-0.075 mg/kg/day (divided BID-TID) | Little added benefit >6 mg/day |
Titration Children: increase by 0.5 mg at 5-7 day intervals
Renal Undefined
Hepatic Undefined
Instructions
- Individualize dose; reduce gradually to lowest effective maintenance level
- Withdraw gradually to reduce risk of withdrawal-emergent dyskinesia
- Switching from injectable: give first oral dose 12-24 h after last parenteral dose
Contraindications
- Severe toxic CNS depression or comatose states from any cause
- Parkinson's disease
Cautions
- Increased mortality in elderly with dementia-related psychosis (boxed)
- Tardive dyskinesia / tardive dystonia (may be irreversible)
- Neuroleptic malignant syndrome
- QT prolongation and Torsades de pointes; sudden death reported
- Extrapyramidal symptoms, especially early and at higher doses
Adverse reactions
- Extrapyramidal symptoms (parkinsonism, akathisia, dystonia)
- Tardive dyskinesia
- Sedation, restlessness, insomnia
- Tachycardia, hypotension/hypertension, QT prolongation
- Dry mouth, blurred vision, urinary retention
- Neuroleptic malignant syndrome
Pregnancy Undefined
Lactation Undefined
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$10–$300/month
Generic entry1986
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Mechanism of action: Haloperidol ballicule
Open Haloperidol in the interactive console ↗
Memory aids: mascots and interaction avatars
Spooky greyscale mascot → high-potency first generation antipsychotic (FGA)
QT prolongation
Bra → may increase prolactin → gynecomastia risk
