Haloperidol

Haloperidol Brand Name– Haldol | Haldol Decanoate

What is Haloperidol

Haloperidol is a high-potency conventional antipsychotic that is structurally related to droperidol.

Oral formulations of haloperidol and haloperidol lactate intramuscular injection solution are indicated for the symptomatic treatment of schizophrenia and to control tics and vocal utterances of Tourette’s Disorder.

The American Academy of Neurology practice guideline states that haloperidol is probably more likely than placebo to reduce tic severity in patients with Tourette’s syndrome or chronic tic disorders; however, there is insufficient evidence to determine the efficacy of haloperidol relative to other antipsychotics used to treat tics.

Oral haloperidol is also indicated in pediatric patients for the treatment of severe behavioral problems, manifested as impulsive, combative, or explosive hyperexcitability, that are unresponsive to behavioral or counseling therapy.

Haloperidol decanoate is a depot intramuscular injection indicated for adult schizophrenic patients who require prolonged parenteral antipsychotic treatment.

Conventional antipsychotics such as haloperidol have largely been replaced by atypical antipsychotics for various labeled indications. Haloperidol is still fairly commonly used in emergent or hospital settings for the treatment of agitation.

However, IV administration of haloperidol lactate injection solution is not FDA-approved and IV use is associated with an increased risk of QT prolongation and torsade de pointes (TdP); ECG monitoring is recommended if the drug is used by this route.

As with all antipsychotics, the haloperidol labels carry a boxed warning regarding an increased risk of death in elderly patients treated for dementia-related psychosis

Indications

  1. agitation
  2. attention-deficit hyperactivity disorder (ADHD)
  3. autistic disorder
  4. behavioral or psychological symptoms of dementia
  5. chemotherapy-induced nausea/vomiting
  6. delirium
  7. mania
  8. oppositional defiant disorder
  9. schizophrenia
  10. singultus (hiccups)
  11. Tourette’s syndrome

Side Effects

  1. abdominal pain
  2. acneiform rash
  3. agitation
  4. agranulocytosis
  5. akathisia
  6. akinesia
  7. alopecia
  8. amenorrhea
  9. anaphylactoid reactions
  10. anemia
  11. angioedema
  12. anxiety
  13. aplastic anemia
  14. blurred vision
  15. bronchospasm
  16. cardiac arrest
  17. cataracts
  18. cholestasis
  19. confusion
  20. constipation
  21. contact dermatitis
  22. depression
  23. diaphoresis
  24. drowsiness
  25. dyskinesia
  26. dysmenorrhea
  27. dysphagia
  28. dyspnea
  29. dystonic reaction
  30. edema
  31. ejaculation dysfunction
  32. elevated hepatic enzymes
  33. eosinophilia
  34. euphoria
  35. exfoliative dermatitis
  36. fever
  37. galactorrhea
  38. gynecomastia
  39. hallucinations
  40. headache
  41. heat intolerance
  42. hemolytic anemia
  43. hepatic failure
  44. hepatitis
  45. hyperammonemia
  46. hyperglycemia
  47. hyperkinesis
  48. hyperprolactinemia
  49. hypersalivation
  50. hyperthermia
  51. hypertonia
  52. hypoglycemia
  53. hyponatremia
  54. hypotension
  55. hypothermia
  56. impotence (erectile dysfunction)
  57. infection
  58. infertility
  59. injection site reaction
  60. insomnia
  61. jaundice
  62. laryngeal edema
  63. laryngospasm
  64. lethargy
  65. leukopenia
  66. libido decrease
  67. maculopapular rash
  68. mastalgia
  69. menorrhagia
  70. menstrual irregularity
  71. nausea
  72. neonatal abstinence syndrome
  73. neuroleptic malignant syndrome
  74. neutropenia
  75. nystagmus
  76. orthostatic hypotension
  77. osteopenia
  78. pancytopenia
  79. photosensitivity
  80. polydipsia
  81. priapism
  82. pseudoparkinsonism
  83. purpura
  84. QT prolongation
  85. rash
  86. restlessness
  87. retinal pigment changes
  88. retinopathy
  89. rhabdomyolysis
  90. seizures
  91. SIADH
  92. sinus tachycardia
  93. stroke
  94. tardive dyskinesia
  95. thrombocytopenia
  96. torsade de pointes
  97. torticollis
  98. tremor
  99. trismus
  100. urinary retention
  101. urticaria
  102. vasculitis
  103. ventricular fibrillation
  104. ventricular tachycardia
  105. vertigo
  106. visual impairment
  107. vomiting
  108. water intoxication
  109. weight gain
  110. weight loss
  111. withdrawal
  112. xerostomia

Monitoring Parameters

  • CBC
  • ophthalmologic exam
  • serum prolactin
  • urinalysis

Contraindications

  • abrupt discontinuation
  • agranulocytosis
  • ambient temperature increase
  • angina
  • apheresis
  • AV block
  • bradycardia
  • breast cancer
  • breast-feeding
  • cardiomyopathy
  • celiac disease
  • closed-angle glaucoma
  • CNS depression
  • coadministration with other CNS depressants
  • coma
  • dehydration
  • dementia
  • dementia with Lewy bodies
  • driving or operating machinery
  • dysphagia
  • ethanol ingestion
  • females
  • fever
  • geriatric
  • heart failure
  • hematological disease
  • hepatic disease
  • human immunodeficiency virus (HIV) infection
  • hyperparathyroidism
  • hyperprolactinemia
  • hyperthermia
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypotension
  • hypothermia
  • hypothyroidism
  • increased intraocular pressure
  • infertility
  • intravenous administration
  • leukopenia
  • long QT syndrome
  • myocardial infarction
  • neonates
  • neurological disease
  • neutropenia
  • orthostatic hypotension
  • Parkinson’s disease
  • pheochromocytoma
  • pregnancy
  • pregnancy testing
  • prostatic hypertrophy
  • pulmonary disease
  • QT prolongation
  • rheumatoid arthritis
  • seizure disorder
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  • sickle cell disease
  • sleep deprivation
  • strenuous exercise
  • stroke
  • systemic lupus erythematosus (SLE)
  • tardive dyskinesia
  • thyrotoxicosis
  • tobacco smoking
  • torsade de pointes
  • urinary retention
  • visual disturbance

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  • Tricyclic antidepressants
  • Trifluoperazine
  • Trihexyphenidyl
  • Triprolidine
  • Triptorelin
  • Tucatinib
  • Valproic Acid, Divalproex Sodium
  • Valsartan
  • Vandetanib
  • Vardenafil
  • Vasodilators
  • Vasopressin, ADH
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Zafirlukast
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolpidem
  • Zonisamide
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