Haloperidol

Indications
 Oral
Psychoses
Adult: 0.5-5 mg bid/tid, may increase up to 100 mg daily in severe or resistant cases. Usual maintenance: 3-10 mg daily.
Child: >3 yr: Initially, 25-50 mcg/kg daily in 2 divided doses, increased gradually if necessary. Max: 10 mg/day.
Oral
Tourette's syndrome
Adult: Initially, 0.5-1.5 mg tid. Up to 30 mg daily may be required in Tourette's syndrome; adjust dose carefully to obtain optimum response; usual maintenance: 4 mg daily.
Oral
Severe tics
Adult: Initially, 0.5-1.5 mg tid. Up to 30 mg daily may be required in Tourette's syndrome; adjust dose carefully to obtain optimum response; usual maintenance: 4 mg daily.
Oral
Short-term adjunct in severe anxiety or behavioral disturbances
Adult: 0.5 mg bid.
Oral
Restlessness and confusion
Adult: 1-3 mg every 8 hr.
Oral
Intractable hiccup
Adult: 1.5 mg tid, adjust according to response.
Intramuscular
Acute psychosis
Adult: Doses range from 2-10 mg, may be given every hr or at intervals of 4-8 hr, until symptoms are controlled. Max: 18 mg/day. For emergency control of severely disturbed patients: Up to 18 mg may be given IV/IM.
Intramuscular
Nausea and vomiting
Adult: 0.5-2 mg daily. In palliative care, 1.5 mg 1-2 times daily via oral admin or 2.5-10 mg over 24 hr by SC infusion (via a syringe driver).
Subcutaneous
Restlessness and confusion
Adult: 5-15 mg via SC infusion over 24 hr.
Contraindications
 Severe toxic CNS depression; preexisting coma; Parkinson's disease; lactation.
Warnings / Precautions
 Parkinsonism; epilepsy, allergy, angle-closure glaucoma, benign prostatic hyperplasia; severe cardiac or hepatic disease; extremes in temp (hot and cold weather); presence of acute infections or leucopenia; hyperthyroidism; pregnancy, elderly, children. Patients receiving anticoagulants. Discontinue upon signs of neurological toxicity in patients taking haloperidol and lithium.
Adverse Reactions
 Tardive dyskinesia; extrapyramidal reactions. Anxiety, drowsiness, depression, anorexia, transient tachycardia, postural hypotension, leukopenia; anticholinergic side effects.
Potentially Fatal: Neuroleptic malignant syndrome.
Overdose Reactions
 Symptoms of overdosage in children include drowsiness, restlessness, confusion, marked extrapyramidal symptoms and hypothermia. Torsade de pointes may occur in adults. Supportive treatment is recommended. Maintain a patent airway by using an oropharyngeal airway or endotracheal tube or, in prolonged cases of coma, by tracheostomy. Counteract respiratory depression by artificial respiration and mechanical respirators. Hypotension and circulatory collapse may be counteracted by using IV fluids, plasma, or concentrated albumin, and vasopressor agents such as metaraminol, phenylephrine and norepinephrine. Epinephrine should not be used. For severe extrapyramidal reactions, antiparkinson medication should be admin. Monitor ECG and vital signs especially for signs of QT prolongation or dysrhythmias. Continue monitoring until ECG is normal. Treat severe arrhythmias with appropriate anti-arrhythmic measures.
Drug Interactions
 Carbamazepine and rifampicin reduce plasma concentrations. Symptoms of CNS depression may be enhanced by CNS depressants e.g. alcohol, hypnotics, general anaesthetics, anxiolytics and opioids. May reduce antihypertensive action of guanethidine. May increase risk of arrhythmia when used with drugs that prolong QT interval or diuretics that can cause electrolyte imbalance. May increase plasma levels of haloperidol when used with clozapine or chlorpromazine.
Potentially Fatal: Increases lithium blood levels and may predispose to neuroleptic malignant syndrome.
See Below for More haloperidol Drug Interactions
Mechanism of Actions
 Haloperidol blocks postsynaptic dopamine D1 and D2 receptors in the mesolimbic system and decreases the release of hypothalamic and hypophyseal hormones. It produces calmness and reduces aggressiveness with disappearance of hallucinations and delusions.
Absorption: Readily absorbed from the GI tract (oral).
Distribution: Crosses the blood-brain barrier; enters breast milk. Protein-binding: 92%.
Metabolism: Hepatic via oxidative N-dealkylation and reduction of the ketone group; undergoes enterohepatic recycling.
Excretion: Urine and faeces; 12-38 hr (elimination half-life).
Administration
 May be taken with or without food. (May be taken w/ meals to minimise GI irritation.)
Storage Conditions
 Intramuscular: Store at 15-30°C. Oral: Store at 15-30°C. Subcutaneous: Store at 15-30°C.
ATC Classification
 N05AD01 - haloperidol ; Belongs to the class of butyrophenone derivatives antipsychotics.
Storage
 Intramuscular: Store at 15-30°C. Oral: Store at 15-30°C. Subcutaneous: Store at 15-30°C.
Available As
  • Haloperidol 0.2 mg
  • Haloperidol 0.25 mg
  • Haloperidol 0.5 mg
  • Haloperidol 1.5 mg
  • Haloperidol 10 mg
  • Haloperidol 2 mg
  • Haloperidol 2.5 mg
  • Haloperidol 20 mg
  • Haloperidol 3 mg
  • Haloperidol 5 mg
  • Haloperidol 50 mg

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