Haloperidol (Haldol) is a typical antipsychotic drug that is used to treat patients with aggression, mania, schizophrenia, tics, delirium, and vomiting.

Indications of Haloperidol (Haldol):

• Behavioral disorders (tablet, concentrate):

  • Children who exhibit aggressive, explosive hyperexcitability and severe behavioural issues who cannot be explained by quick provocation respond well to it.
  • It should only be administered to kids if psychotherapy or drugs other than antipsychotics have failed to work.

• Hyperactivity (tablet, concentrate):

  • It is recommended for the short-term treatment of hyperactive kids who exhibit excessive motor activity along with conduct issues that include some or all of the symptoms listed below:
    • impulsivity,
    • difficulty sustaining attention,
    • aggression,
    • mood lability, or
    • poor frustration tolerance only after failure to respond to psychotherapy or medications other than antipsychotics.

• Psychotic disorders (tablet, concentrate):

  • Management of manifestations of psychotic disorders.

• Schizophrenia:

  • IM, lactate: Treatment of schizophrenia.
  • IM, decanoate: Treatment of patients with schizophrenia who require prolonged parenteral antipsychotic therapy.

• Tourette disorder (tablet, concentrate, IM lactate):

  • Control of tics and vocal utterances in Tourette syndrome in adults and children.

• Off Label Use of Haloperidol in Adults:

  • Chemotherapy-associated nausea and vomiting (breakthrough) (adults)
  • Chorea of Huntington disease
  • Delirium and/or agitation, intensive care unit (treatment) (alternative agent)
  • Nausea and vomiting in advanced or terminal illness
  • Obsessive-compulsive disorder
  • Postoperative nausea and vomiting, prevention
  • Psychosis/agitation associated with dementia
  • Rapid tranquilization (agitation/aggression/violent behavior)

Haloperidol (Haldol) dose in adults:

Haloperidol (Haldol) dose to treat Chemotherapy-induced nausea and vomiting (off-label):

• Breakthrough nausea/vomiting:

  • Oral, IV (off-label route): 0.5 to 1 mg every 6 hours as needed.

Haloperidol (Haldol) dose in the treatment of Chorea of Huntington disease (off-label):

• Initial: 0.5 to 2 mg per oral dose each day, depending on response and tolerability, with a daily dose cap of 10 mg.
• To more clearly clarify the role of haloperidol in this scenario, more information could be required.

Haloperidol (Haldol) Dose as an alternative agent in the treatment of Delirium and/or agitation in the intensive care unit (off-label):

Note: Nonpharmacologic therapies and the treatment of underlying disorders are the first steps in preventing and managing delirium. If disturbing symptoms (such as agitation or anxiety) are present, antipsychotics may be administered as a short-term supplementary treatment.

• IV (off-label route): Initial:
  • 0.5 to 10 mg, depending on the level of agitation; if there is insufficient reaction, repeat or increase bolus dose every 15 to 30 minutes until calm is attained; if necessary, provide 25% of entire bolus dose every 6 hours.
  • It is necessary to regularly check the ECG and QTc interval.
  • Haloperidol therapy should be tapered off gradually once symptoms go away.

Note: Continuous infusions in the range of 0.5 to 40 mg/hour with an optional 2.5 mg loading dosage can be administered to patients who are refractory.

Haloperidol (Haldol) dose in the treatment of Nausea and vomiting in advanced or terminal illness (palliative care; off-label):

• Oral, SubQ (off-label route): Initial:
  • 1.5 to 3 mg/day;
  • Up to 6 mg per 24 hours, titrate daily based on response and tolerability.
  • Additional data may be necessary to further define the role of haloperidol in this condition.

Haloperidol (Haldol) dose in the treatment of Nausea and vomiting in advanced cancer:

• Oral:One or two doses of 1.5 to 2.5 mg per day.
• SubQ: 1 to 2 mg administered subcutaneously 2 to 3 times daily, or 1 to 5 mg continuously infused over the course of a day.

Haloperidol (Haldol) dose in the treatment of Obsessive-compulsive disorder (off-label):

• Initial dose: 2 mg/day taken orally; dose adjustment of 2 mg every 3 days, up to a maximum dose of 10 mg/day, based on response and tolerability.
• 6 mg/day was the typical dose during the clinical trial.
• To clarify the function of haloperidol in this situation, more information could be required.

Haloperidol (Haldol) Dose in the prevention of postoperative nausea and vomiting, (off-label):

• IM, IV (off-label route): 0.5 to 2 mg.

Haloperidol (Haldol) Treatment dose of Psychosis:

• Manufacturer's labeling:

  • 0.5 to 5 mg per mouth, taken two to three times a day; dose is adjusted according to response and tolerance.
  • According to the manufacturer, daily dosages of up to 100 mg may be required for optimum response. Patients who are very resistant to treatment may occasionally need doses above 100 mg.
  • 5 to 20 mg/day is the recommended dosage range for schizophrenia.

Haloperidol (Haldol) dose for Rapid tranquilization (agitation/ aggression/ violent behavior) (off-label):

• IM (as lactate): 2.5 to 10 mg.

Haloperidol (Haldol) Treatment dose of Schizophrenia:

• IM (as lactate):
  • 2 to 5 mg; successive doses may be given as frequently as every 60 minutes, however intervals of 4 to 8 hours may suffice.
  • maximum: 20 mg/day.
• IM (as decanoate):
• Note:
  • Before switching to IM decanoate injection, achieve tolerance to oral haloperidol first.
  • 10–20 times the recommended daily oral dose at first. Regardless of past antipsychotic requirements, the initial dose should not be more than 100 mg. Give the amount in two injections if the conversion of the initial dose is greater than 100 mg.
• Oral haloperidol ≤10 mg/day, elderly, or debilitated:
  • Initiate dose at 10 to 15 times the daily oral dose.
• Oral haloperidol >10 mg/day or high risk of relapse:
  • Initiate dose at 20 times the daily oral dose.
• Maintenance dose:
  • 10–15 times the daily oral dose before, or 50–200 mg.
  • At 4-week intervals, provide dosages; adjust the dose based on the patient's response and tolerance.
• Oral overlap:
  • After the first dose, taper the oral dosage, and stop after the next two or three injections (ie, 60 to 90 days).
  • Depending on the clinical response and the presence of side effects, change the rate of taper.

• Alternative dosing regimen:

  • Loading dose regimen:
    • Initial: 20 times the daily oral dose that was taken previously, divide the entire amount, and administer every 3 to 7 days. The maximum dose for one injection is 250 mg, and oral haloperidol should be stopped prior to the first one.
    • Depending on the clinical response, lower the dose by 25% each month from months two to four before establishing the maintenance dose.
  • Usual maintenance dose:
    • 200 mg per month.

Haloperidol (Haldol) dose in the treatment of Tourette syndrome:

• Orally: 0.5 to 5 mg 2–3 times per day; dose adjustment based on response and tolerability.
• The European Society for the Study of Tourette Syndrome suggests a dose range of 0.25 to 15 mg/day, while Tourette Canada Guidelines propose a range of 0.5 to 3 mg/day.
• According to the manufacturer, daily dosages up to 100 mg may be required in some circumstances for the best outcome; doses beyond 100 mg have rarely been used in individuals who are extremely resistant to treatment.

• Dosing Conversion:

  • IM (as lactate) to oral:
    • As a starting point for estimating the total daily dose needed for the oral formulation, use the entire IM (as lactate) dose that was given over the previous 24 hours.
    • Within 12 to 24 hours of the final intravenous (as lactate) dose, the first oral dose should be begun.
  • Oral to IM (as decanoate):
    • See schizophrenia dosing.

• Discontinuation of therapy:

  • A progressive dose reduction should be carried out in order to prevent withdrawal symptoms (such as insomnia, headaches, and GI symptoms), unless stopping the medication is necessary owing to serious negative effects.
  • When terminating chronic antipsychotic therapy in individuals with schizophrenia or bipolar disorder, the dose should be lowered gradually over months to years with close monitoring to allow for the discovery of prodromal symptoms of disease recurrence.

• Switching antipsychotics: Limited data available; optimal universal strategy is unknown.

  • Cross-titration, which progressively reduces the first antipsychotic while gradually raising the new antipsychotic, and sudden shift are other techniques (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose).
  • When a patient with schizophrenia has a high risk of relapsing, the initial medication may be progressively reduced and withdrawn over a period of one to two weeks. The present medication may be kept at the full dose while the new medication is raised (i.e., overlap).
  • Clinical experience has led some specialists to believe that cross-titration and overlap strategies are preferable than sudden change.

Haloperidol (Haldol) dose in children:

Note: 

• Depending on the patient's reaction, the dosage should be customised.
• Once a sufficient treatment response has been attained, gradually reduce the dose to the lowest effective maintenance dosage.

Note: Use caution while prescribing and dispensing; dosage is offered as fixed (mg) dosing and weight-based (mg/kg) dosing.

Haloperidol (Haldol) dose in the treatment of nonpsychotic behavior disorders:

• Children 3 to 12 years weighing 15 to 40 kg:

  • Oral: 0.05 to 0.075 mg/kg/day in 2 to 3 divided doses is the typical maintenance range. The first dose is 0.5 mg/day in 2 to 3 divided doses, and the dose may be increased by 0.5 mg every 5 to 7 days.
  • Children with severe, nonpsychotic problems may need greater doses; nevertheless, no improvement has been seen with dosages >6 mg/day. The maintenance range equates to a fixed dose of 0.75 to 3 mg/day in divided doses.

• Children >40 kg and Adolescents: Limited data available:

  • Oral: 0.5 to 15 mg/day, split into 2 to 3 doses; start at the lower end of the range and adjust as necessary (no more frequently than every 5 to 7 days).
  • 15 mg is the maximum daily dosage.
  • Refractory or severe illnesses may call for higher doses.

Haloperidol (Haldol) dose for the treatment of Delirium: Limited data available; optimal dose not established;

Note: Because there is so little reported experience with infants, smaller doses might be necessary.

• Infants ≥3 months, Children, and Adolescents:

  • IV (lactate, immediate release):
    • Loading dose:
      • 0.15 to 0.25 mg/dose infused slowly over 30 to 45 minutes.
    • maintenance dose:
      • 0.05 to 0.5 mg/kg/day in divided doses.
  • Retrospective analysis of 27 children (3 months to 17 years old) treated with this dosage revealed that all patients' delirium-related symptoms improved with treatment; nevertheless, two patients developed dystonic responses.
  • In a small case series, loading doses of 0.025 to 0.1 mg/kg/dose administered every 10 minutes until sedation was achieved (reported total haloperidol loading dose: 0.09 to 0.25 mg/kg total) were described, followed by maintenance doses of 0.06 to 0.45 mg/kg/day in divided doses every 6 to 8 hours (n=5; age range: 9 months to 16 years); infants (n=2) were noted to require lower doses (total loading

Haloperidol (Haldol) dose in the treatment of Psychotic disorders:

• Children 3 to 12 years weighing 15 to 40 kg:

  • Initial: 0.5 mg/day per oral in two to three divided doses; increase by 0.5 mg every five to seven days to the typical maintenance range of 0.05 to 0.15 mg/kg/day in two to three divided doses (maintenance range calculates to a fixed dose of 0.75 to 6 mg/day in divided doses); Higher doses may be required in severe or refractory cases; maximum dose is unknown; for adolescents, the daily maximum dose is 15 mg.

• Children >40 kg and Adolescents: Limited data available:

  • Start at the lower end of the range and may raise as necessary; the dosage ranges from 0.5 to 15 mg/day per mouth in 2 to 3 split doses (no more frequently than every 5 to 7 days).
  • 15 mg is the maximum daily dosage.
  • Refractory or severe illnesses may call for higher doses.

Haloperidol (Haldol) Treatment dose of Acute Agitation and psychosis: Limited data available:

• Infants, Children, and Adolescents:

  • IM, IV (lactate, immediate release):
    • 0.05 to 0.15 mg/kg; may be repeated hourly as needed.
  • maximum dose: 5 mg/dose.

Haloperidol (Haldol) Treatment dose of Agitation (palliative care): Limited data available:

• Children ≥3 years and Adolescents:

  • 0.025 to 0.05 mg/kg once, then may repeat 0.025 mg/kg/dose in one hour as needed, to manage new-onset acute episode. 0.01 mg/kg/dose per oral three times day as needed.

Haloperidol (Haldol) Treatment dose of Tourette syndrome:

• Children 3 to 12 years weighing 15 to 40 kg:

  • Manufacturer's labeling:
    • Initial: 0.5 mg/day per oral in 2 to 3 divided doses; increase by 0.25 to 0.5 mg every 5 to 7 days to the usual maintenance of 0.05 to 0.075 mg/kg/day in 2 to 3 divided doses (maintenance range calculates to a fixed dose of
    • 0.75 to 3 mg/day in divided doses); maximum dose is unknown, but doses greater than 6 mg/day have not been shown to improve symptoms in patients with nonpsychotic disturbances.
  • Alternate dosing: Limited data available:
    • Initial: 0.25 to 0.5 mg/day orally, divided into 2 to 3, then increased to a typical daily dose range of 1 to 4 mg/day.

• Children weighing >40 kg and Adolescents: Limited data available:

  • Start at the lower end of the range and may raise as necessary; range: 0.25 to 15 mg/day per mouth in 2 to 3 split doses (no more frequently than every 5 to 7 days)
  • The typical dose range is 1 to 4 mg/day; the maximum dose has not been determined. However, doses greater than 6 mg/day have not been demonstrated to ameliorate symptoms in patients with nonpsychotic disorders.

• Discontinuation of psychosis therapy:

  • Children and Adolescents:

    • Drugs should be tapered off gradually to prevent withdrawal symptoms and reduce the risk of relapse, according to the manufacturer and guidelines from the American Academy of Child and Adolescent Psychiatry (AACAP), American
    • Psychiatric Association (APA), Canadian Psychiatric Association (CPA), National Institute for Health and Care
    • Excellence (NICE), and World Federation of Societies of Biological Psychiatry (WFSBP).
    • High doses of antipsychotics that are strongly anticholinergic or dopaminergic may carry the greatest risk for withdrawal symptoms.
    • When discontinuing antipsychotic medicine in people with schizophrenia, the CPA recommendations advise a slow taper spanning 6 to 24 months, whereas the APA guidelines advise a 10% monthly dose reduction.
    • Anti-parkinsonism medications can be kept in the system for a brief amount of time after termination to avoid withdrawal symptoms.
    • When switching antipsychotics, three strategies have been suggested:
      • Cross-titration, overlap and taper (gradually reducing the first antipsychotic while gradually increasing the new antipsychotic), abrupt change, and maintaining the first antipsychotic dose while gradually increasing the new antipsychotic, respectively (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose).
    • There is little evidence to support ideal taper rates and switch tactics, and the results are inconsistent.

Haloperidol (Haldol) Pregnancy Risk Category: C

• Studies on animal reproduction revealed that there were adverse results. Humans have the potential to cross the placenta with haloperidol.
• While haloperidol is not a major human teratogen but it can cause limb malformations if exposed during the first trimester.
• If haloperidol was used in the third trimester, extrapyramidal and withdrawal symptoms may occur in newborns after delivery.
• The newborn can experience agitation, feeding disorders, hypertonia and hypotonia as well as respiratory distress, somnolence and tremor.
• These symptoms may be self-limiting, or may require hospitalization.
• The minimum maternal dose should be used to reduce the risk.

Use of haloperidol while breastfeeding

• Haloperidol, which is secreted in breastmilk, has been found in plasma and urine from breastfeeding infants.
• Haloperidol may cause breast engorgement, gynecomastia and lactation.
• Manufacturers do not recommend breastfeeding.

Haloperidol (Haldol) Dose adjustment in renal disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Haloperidol (Haldol) Dose adjustment in liver disease:

There are no dosage adjustments provided in the manufacturer's labeling; however, haloperidol concentrations may increase in patients with hepatic impairment because it is primarily metabolized by the liver and protein binding may decrease.

Common Side Effects of Haloperidol (Haldol):

• Central nervous system:

  • Extrapyramidal reaction
  • Parkinsonism

Rare Side Effects of Haloperidol (Haldol):

• Central Nervous System:

  • Dystonia
  • Hypertonia
  • Drowsiness
  • Akathisia
  • Headache

• Gastrointestinal:

  • Constipation
  • Abdominal Pain
  • Xerostomia
  • Sialorrhea

• Neuromuscular & Skeletal:

  • Hyperkinetic Muscle Activity
  • Tremor
  • Bradykinesia
  • Akinesia

• Ophthalmic:

  • Oculogyric Crisis

Haloperidol (Haldol) Side effects (Frequency Not Defined):

• Central Nervous System:

  • Anxiety
  • Euphoria
  • Lethargy
  • Psychotic Symptoms (Exacerbation)
  • Vertigo

• Dermatologic:

  • Diaphoresis

• Endocrine & Metabolic:

  • Hyperglycemia
  • Hyponatremia
  • Increased Libido
  • Menstrual Disease

• Gastrointestinal:

  • Anorexia
  • Diarrhea
  • Dyspepsia

• Genitourinary:

  • Breast Engorgement
  • Impotence
  • Lactation

• Ophthalmic:

  • Cataract
  • Retinopathy
  • Visual Disturbance

• Respiratory:

  • Increased Depth Of Respiration

Contraindications to Haloperidol (Haldol):

• Hypersensitivity to haloperidol and any component of the formulation
• Patient with Comatose
• Parkinson disease
• Severe depression CNS
• Lewy bodies and dementia

Canadian labeling: Additional contraindications not in US labeling

• Young children
• Depressive states are a significant concern
• Spastic diseases: History

Warnings and precautions

• Modified cardiac conduction

  • QT prolongation, sudden death, and torsades can be caused by haloperidol. Higher risk is associated with IV or IM laxtate injections in higher doses.
  • Patients at higher risk for negative consequences include those with hypothyroidism, familial long QT syndrome, and electrolyte problems (such as hypokalemia or hypomagnesemia).
  • It's crucial to obtain a baseline ECG before beginning treatment.
  • The baseline ECG should show a prolonged QTc or cumulative dosages greater than 2 mg if the patient is at risk for QTc prolongation due to specific circumstances.
  • A continuous monitoring of ECG may be necessary.
  • During therapy, electrolyte levels should be monitored.
  • Dosis reduction or alternative therapies should be taken into consideration if the QTc interval lengthens by 20% to 25%, is greater than 500 msec, or if the T-waves or U-waves on the ECG flatten.

• Anticholinergic effects

  • Treatment with haloperidol may result in anticholinergic side effects such diarrhoea, xerostomia, and vision impairment.
  • Patients who have impaired vision, paralytic ileus, urine retentions, BPH, xerostomia, or poor gastrointestinal motility are more at risk.
  • Therefore, it is important to use caution when using this medication.
  • Comparable to other neuroleptics, Haloperidol's cholinergic blockage potency is lower than that of Haloperidol.

• Blood dyscrasias

  • Leukopenia and neutropenia, two symptoms of myelosuppression that can be treated with antipsychotics (sometimes fatal).
  • Risk factors include a history of drug-induced neutropenia or a pre-existing low WBC. As a result, both routine and emergency blood count examinations are required.
  • Therapy should be stopped if there are any signs of blood disorders or an absolute neutrophil count below 1,000/mm3.

• Depression in the CNS:

  • CNS depression can cause haloperidol-related impairments in mental or physical abilities.
  • It is important to warn patients about tasks that require mental alertness, such as driving or operating machinery.

• Esophageal dysmotility/aspiration

  • Antipsychotic use can lead to esophageal dysmotility or aspiration, which is more common in the elderly.
  • It should not be used if patients over 75 years old are at high risk of aspiration pneumonia (ie Alzheimer's disease).

• Extrapyramidal symptoms

  • Haloperidol can cause extrapyramidal symptoms (EPS), such as pseudo parkinsonism and acute dystonic reactions.
  • Young patients are at greater risk for dystonia due to increased dosages of antipsychotics and increased male gender.
  • There are many factors that increase the risk of tardive dyskinesia, including elderly people, DM, alcoholics, female gender with postmenopausal status and Parkinson disease symptoms, pseudo parkinsonism symptoms and affective disorders (especially major depressive disorder), brain damage, poor treatment responses, high doses antipsychotics, and previous brain damage.
  • If you experience tardive dyskinesia symptoms, it is important to stop all therapy.

• Falls

  • Increased falls can be caused by somnolence, orthostatic hypertension, motor or sensory instability, and haloperidol.
  • Patients with certain diseases or medications that can increase fall risk should have their fall risk assessed at baseline and again periodically throughout treatment.

• Hyperprolactinemia

  • Hyperprolactinemia can be caused by haloperidol.
  • It is unknown, though, whether people with breast cancer or other prolactin-dependent malignancies experience hyperprolactinemia.

• Hypersensitivity

  • It can lead to hypersensitivity, which includes exfoliative dermatologtitis and anaphylactic responses.

• Neuroleptic malignant Syndrome:

  • Haloperidol therapy can cause neuroleptic malignant symptoms.
  • Therefore, it is important to monitor for changes in mental status, fever, rigidity and/or autonomic instability.
  • After recovery from the syndrome, it is important to carefully consider reintroducing drug therapy. 
  • Before rechallenge, the drug should be administered at least two weeks after recovery. A lower-potency antipsychotic should also be used.
  • Monitoring closely for NMS reemergence is important.

• Orthostatic hypotension

  • Orthostatic hypotension is a known side effect of haloperidol.
  • It should not be used in patients who are at high risk for this effect, or those who cannot tolerate temporary hypotensive episodes due to cardiovascular disease, cerebrovascular disease, hypovolemia, concurrent medication use, or hypotension/bradycardia.
  • Compared to other neuroleptics, haloperidol has a decreased risk of orthostatic hypotension.

• Temperature regulation

  • Haloperidol therapy can cause impaired core body temperature regulation.
  • Strenuous exercise, heat exposure and dehydration increase the risk.

• Cardiovascular disease

  • Patients with severe cardiovascular disease should not use it because of the possibility of angina or transient hypotension.

• Bipolar disorder

  • When mania control is utilised, patients with bipolar disorder may experience abrupt mood swings into sadness. Extreme caution should be exercised in handling this.
  • Haloperidol is not antidepressant.

• Dementia: [US Boxed Warning]

  • As compared to placebo, the risk of death in dementia-related psychosis patients aged over 65 is higher when they are treated with antipsychotics.
  • The majority of deaths were either from cardiovascular disease (eg heart failure, sudden death, etc.) or infectious diseases (eg pneumonia).
  • Avoid using haloperidol in elderly patients suffering from dementia-related psychosis.
  • Haloperidol has not been approved to treat dementia-related psychosis.
  • Patients with dementia with Lewy bodies are advised to avoid taking haloperidol.
  • These patients are more sensitive than others to antipsychotic medication and may experience severe extrapyramidal symptoms, confusion, and falls.

• Parkinson disease

  • Patients with Parkinson's disease are advised to avoid haloperidol.
  • Antipsychotic medicine may cause more severe extrapyramidal symptoms, disorientation, and falls in these people because they are more sensitive to it.

• Seizure disorder

  • Patients at high risk of seizures should not be given haloperidol. It can lower the seizure threshold.
  • Patients with a history or concurrent anticonvulsant therapy, seizures, EEG abnormalities, and/or a history of seizures are at greater risk.

• Thyroid dysfunction

• Patients with thyrotoxicosis may experience severe neurotoxicity, such as rigidity, inability walk or talk, and haloperidol therapy should be avoided.

Haloperidol: Drug Interaction

Monitoring parameters:

• Vital signs (as indicated by a doctor)
• Mental health
• At every visit, for the first six months, weight, height, waist circumference, and BMI (baseline)
• CBC (as indicated by the doctor; patients who have a history of drug-induced leukopenia/neutropenia or low WBC should be monitored frequently in the first few months.
• LFTs and electrolytes (yearly and as indicated by a physician)
• Fasting plasma glucose/ HbA1c
• Baseline Lipid Profile; Repeat every 2 years if your LDL level has reached normal levels; repeat every 6 month if it is greater than 130 mg/dL;
• ECG (as indicated by a physician and with intravenous administration off-label); every quarter with stable antipsychotic dosage
• Changes in menstruation, fertility, and development of galactorrhea (at each visit for 12 weeks after antipsychotic administration or until the dose becomes stable, then annually)
• Parkinsonian signs or abnormal involuntary movements (baseline; continue weekly until dose stabilization for at least two weeks after introduction, and for at most 2 weeks following any significant dose increases)
• Every six months, tardive dyskinesia develops, and every three months in high-risk patients.
• Every year, inquire about visual changes.
• a visual inspection annually for patients over 40; every two years for patients under 40
• ICU delirium
  • Follow the Intensive Care Delirium Screening Checklist or the Confusion Assessment Method (CAM-ICU)

How to administer Haloperidol (Haldol)?

Injection oil (decanoate).

• Only IM administration of the injectable decanoate formulation is recommended. It shouldn't be given intravenously.
• Use of a 21-gauge needle is advised.
• Z-track injection techniques can be utilised to prevent leakage after injections. The maximum capacity for injection locations shouldn't be more than 3 ml.
• Haloperidol can be given by deltoid injection, despite the fact that specialists advise deep IM injections into the gluteal muscles.

Injection solution (lactate).

• You can use an IV or an IM to administer the lactate injectable solution (off-label route).
• Although reports have indicated rates as high as 5 mg/minute or 0.125 mg/kg in a matter of minutes, it is unclear what the pace of IV delivery should be.

Notice:

• ECG monitoring is required for QT prolongation or arrhythmias. IV administration can cause QT prolongation, according to the manufacturer.
• Individual institutional policies and procedures must be reviewed before any therapy.
• It has been reported that subcutaneous administration can also be used (mostly in palliative care settings), either intermittently or continuously.

Mechanism of action of Haloperidol (Haldol):

Haloperidol, a butyrophenone-antipsychotic, works by nonselectively blocking the brain's postsynaptic dopaminergic D receptors.

The onset of action: Lactate:

• IM: Sedation: Mean: 28.3 minutes
• IV: Sedation: 3 to 20 minutes

Peak effect: Lactate:

• IV: Sedation: ~30 minutes

Duration: Lactate (dose-dependent):

• IM: Sedation: Mean: 126.5 minutes
• IV: Sedation: Reported range: 3 to 24 hours

Protein binding:

• 88.4% to 92.5%

Metabolism:

• 20% to 30% of CYP3A4-mediated N-dealkylation, including a modest oxidation pathway to hazardous pyridinium derivative, occurs in the liver, along with 50% to 60% glucuronidation (inactive), 23% CYP3A4-mediated reduction to inactive metabolites, and some back-oxidation to haloperidol.

Bioavailability:

• Oral: 60% to 70%

Half-life elimination:

• Decanoate:
  • 21 days
• Lactate:
  • IM: 20 hours
  • IV: 14 to 26 hours
  • Oral: 14 to 37 hours

Time to peak, serum:

• Decanoate:
  • 6 days
• Lactate:
  • IM: 20 minutes
  • Oral: 2 to 6 hours

Excretion:

• Urine (30%, 1% as unchanged drug)

International Brand Names of Haloperidol:

• Haldol;
• Haldol Decanoate
• APO-Haloperidol
• Haloperidol-LA Omega
• PMS-Haloperidol
• PMS-Haloperidol LA
• TEVA-Haloperidol
• Aloperidin
• Avant
• Decadol
• Galopril
• Haldec
• Haldol
• Haldol Decanoas
• Haldol decanoas
• Haldol Decanoate
• Haldol Decanoato
• Haldol depo
• Haldol Depot
• Halonace
• Halop
• Haloper
• Haloperidol Decanoat
• Haloperidol Esteve
• Haloperidol Prodes
• Haloperidol-ratiopharm
• Haloperil
• Halopidol decanoato
• Haloslip
• Haloxen
• Haridol Decanoate
• Haridol-D
• Hazidol
• Holt
• Manace
• Mapress
• Motivan
• Norodol
• Peldol
• Pericate
• Peridol
• Perol
• Senorm L.A.
• Seranace
• Seredol Deca
• Serenace
• Serenase
• Serenase Dekanoat
• Starhal
• Sutran X
• Zocalm-5
• Zuredel

Haloperidol Brand Names in Pakistan: