Haloperidol (Haldol): Uses, Dose, and Side Effects

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Haloperidol is an antipsychotic mainly used to treat psychosis, where you cannot distinguish between imagination and reality. So, haloperidol, which goes by the brand name of Haldol, finds use in schizophrenia and schizoaffective disorder where psychotic symptoms are prominent. It also has other uses. It works by restoring the balance of neurotransmitters (natural chemicals in the brain). It is called a first-generation antipsychotic or typical antipsychotic, in that certain side effects like extrapyramidal symptoms are more common than with atypical antipsychotics. Haldol dose is based on the extent and severity of your symptoms and your response to initial treatment.

Tote bag with haloperidol chemical structure on it
Haloperidol Tote Bag (Pic Credit: https://www.cafepress.com/)

Uses of Haloperidol

The uses of haloperidol are in the treatment of the following conditions (Cunha, n.d.), (MedlinePlus, 2017):

  • Psychotic mental disorders like schizophrenia and schizoaffective disorder – it decreases hallucinations and delusions, helps you think more clearly, reduces aggression, makes you less nervous and more willing to take part in the everyday activities, and also reduces the risk of suicide in people who are likely to harm themselves.
  • Motor tics (uncontrollable need to repeat certain body movements) and verbal tics (uncontrollable need to repeat sounds or words) in children and adults who have Tourette’s disorder.
  • Involuntary movements caused by Huntington’s disease (Ritter, et al., 2020, p. 598).
  • Severe behavioral problems like hyperactivity or explosive and aggressive behavior in children when other therapies and medications have not helped.
  • May be useful for controlling aggression in Alzheimer’s disease, but sedation and extrapyramidal symptoms limit its use to control of acute episodes (Brunton, 2018, p. 334).
  • Acute chemotherapy-induced emesis (Ritter, et al., 2020, p. 403).
  • Sometimes used to treat mania in bipolar depression (Ritter, et al., 2020, p. 621).
  • Severe anxiety.

Dose of Haloperidol

Dose for Schizophrenia (Brunton, 2018, p. 283)

Adults

Acute psychosis, 1st episode – 2.5-10 mg/day (depot IM inj. 100-200 mg/week – max 3 loading doses)

Acute psychosis, chronic – 5-20 mg/day (depot IM inj. 100-200 mg/week – max 3 loading doses)

Maintenance, 1st episode – 2.5-10 mg/day (depot IM inj. 100-400 mg/month)

Maintenance, chronic – 5-15 mg/day (depot IM inj. 100-400 mg/month)

Dose for Tourette Disorder (Cunha, n.d.)

  • Adults: 0.5-2 mg orally every 8-12 hours to begin with; depending on response of symptoms, consider titrating to 3-5 mg orally every 8-12 hours; if the patient remains inadequately controlled, daily doses may go up to 100 mg (may not be safe)
  • Children under 3 years: Safety and efficacy not established
  • Children 3-12 years: 0.5 mg/day orally to begin with; then, increased by 0.5 mg every 5-7 days until the desired effect achieved, then reduced to lowest effective maintenance level of 0.05-0.075 mg/kg/day orally divided every 8-12 hours
  • Children over 12 years: 0.5-2 mg orally every 8-12 hours to begin with; if symptoms not controlled, titrate to 3-5 mg orally every 8-12 hours; if still inadequately controlled, daily doses can be tried up to 100 mg (safety not determined)

Dose for Behavioral Disorders in Children (Cunha, n.d.)

  • Children under 3 years: Safety and efficacy not established
  • Children 3-12 years: 0.5 mg/day orally to begin with; increased as needed by 0.5 mg every 5-7 days until the desired effect achieved, then reduced to lowest effective maintenance level of 0.05-0.075 mg/kg/day orally divided every 8-12 hours

Dose for Acute Agitation in Children (Cunha, n.d.)

  • Children under 12 years: Safety and efficacy not established
  • Children over 12 years: 0.5-3 mg orally, repeated hourly as needed; or, 2-5 mg intramuscularly (IM), hourly as needed

What if I miss a dose?

Take the missed dose as soon as you remember. But, if it is almost time for the next dose, skip the missed dose. Do not double the dose to make up for a missed one.

What if I overdose?

Seek emergency medical help if the following symptoms of overdose occur: Unusual, slowed, or uncontrollable movements of any part of the body, Stiff or weak muscles. Slowed breathing, Sleepiness, and Loss of consciousness.

Side Effects of Haldol (Cunha, n.d.) (WebMD, n.d.)

Some of the common side effects of haloperidol are:

  • Drowsiness
  • Weight gain
  • Parkinsonism (muscle stiffness, tremor, restlessness, mask-like facial expression, etc.) – contact your doctor immediately if this occurs
  • Irregular menstrual periods
  • Dry mouth
  • Blurred vision
  • Restlessness
  • Extrapyramidal symptoms at high doses (contact your doctor):
    • Acute dystonias: involuntary movements (restlessness, muscle spasms, protruding tongue, fixed upward gaze, neck muscle spasm). They occur commonly in the first few weeks, often declining with time, and are reversible on stopping drug treatment.
    • Tardive dyskinesia: It develops after months or years of treatment. It consists of involuntary movements, often of the face and tongue, but also of trunk and limbs.
  • Neuroleptic malignant syndrome: Symptoms of high fever, muscle stiffness or pain or weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, change in the amount of urine. These may be symptoms of a rare and serious condition that can lead to death. Contact emergency medical services immediately.

Some less common side effects of haloperidol include:

  • Anhedonia (loss of capacity to experience pleasure)(Brunton, 2018, p. 282)
  • Dizziness upon standing, after intramuscular injection
  • Agitation, confusion
  • Increased heart rate
  • Anxiety
  • Difficulty in urinating
  • Fluid collection in brain
  • Depression
  • Headache
  • Sleeplessness
  • Euphoria
  • Impaired temperature regulation
  • Loss of appetite
  • Indigestion and constipation

Rare side effects of Haldol include:

  • Increased sensitivity to light
  • Itching
  • Diarrhea
  • Seizures
  • Jaundice
  • Prolonged erection
  • ECG changes
  • Allergic reaction: Symptoms include swollen, pale red bumps or wheals on the skin that appear suddenly, and cause itching and burning sensation; difficulty in breathing; swelling of face, lips, tongue, or throat. Get emergency medical help.

Precautions and Warnings for Haloperidol (Cunha, n.d.) (MedlinePlus, 2017)

  • It is not approved for treating dementia-related psychosis because haloperidol can cause an increased risk of death in them.
  • Keep out of reach of children. In case of overdose, get medical help immediately.
  • The safety of long-term dosage of 100 mg/day orally is not established.
  • Haloperidol may make you drowsy and may affect your thinking and movements. Do not drive a car or operate machinery until you know how this medication affects you.
  • Stay hydrated if undergoing strenuous exercise, heat exposure, and dehydration because haloperidol impairs body temperature regulation.
  • Use caution in patients with severe cardiovascular disorders, because of the possibility of transient hypotension and/or precipitation of angina pain.
  • In patients receiving medications for seizures, with a history of seizures, or with EEG abnormalities, haloperidol may lower the threshold for seizures.
  • Tell your doctor if there is a family history of prolonged QT syndrome – a condition that increases the risk of developing an irregular heartbeat that may cause loss of consciousness or sudden death.
  • Do not get up too quickly from lying or sitting position on account of the possibility of a sudden drop in BP (postural hypotension).

Use during Pregnancy and Lactation

Haloperidol use during pregnancy may be acceptable if benefits outweigh risks. Neonates exposed to antipsychotic drugs such as clozapine during the last three months of pregnancy are at risk for extrapyramidal symptoms (EPS) or withdrawal symptoms after delivery; these complications vary in severity, with some being self-limited and others requiring ICU support and prolonged hospitalization.

Clozapine enters breast milk; so, its use is not recommended while breastfeeding.

Interactions with Haloperidol (Cunha, n.d.) (WebMD, n.d.)

Haloperidol has serious interactions with over 80 different drugs.

Haloperidol has moderate interactions with over 300 different drugs.

Haloperidol has mild interactions with over 40 different drugs.

Drugs that can increase the effects of drowsiness and sedation that occur with haloperidol are opioid pain or cough relievers, alcohol, marijuana, drugs used to treat insomnia or anxiety, muscle relaxants, or antihistamines.

References

Brunton, L., 2018. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 13 ed. New York: McGraw Hill.

Cunha, J., n.d. Haloperidol. [Online]
Available at: https://www.rxlist.com/consumer_haloperidol_haldol/drugs-condition.htm
[Accessed 6 Sep 2019].

MedlinePlus, 2017. Haloperidol. [Online]
Available at: https://medlineplus.gov/druginfo/meds/a682180.html
[Accessed 6 Sep 2019].

Ritter, J. et al., 2020. Rang and Dale’s Pharmacology. 9 ed. Edinburgh: Elsevier.

WebMD, n.d. Haloperidol. [Online]
Available at: http://www.webmd.com/drugs/2/drug-8661/haloperidol-oral/details
[Accessed 6 Sep 2019].

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Haloperidol (Haldol): Uses, Dose, and Side Effects
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Haloperidol (Haldol): Uses, Dose, and Side Effects
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Haloperidol (Haldol) is an antipsychotic used mainly in schizophrenia & schizoaffective disorder. Extrapyramidal side effects can occur.
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