Class
- Antipsychotic
Haloperidol
Commonly Prescribed for
(FDA approved in bold)
- Tics in Gilles de la Tourette syndrome (GTS)
- Psychotic disorders
- Short-term treatment of severe behavior problems in children
- Severe behavioral problems in children (second-line)
- Short-term treatment of hyperactivity in children (second-line)
- Schizophrenia (long-term parenteral therapy)
- Bipolar disorder
- Nausea and vomiting
- Headache
- Behavioral disturbances in dementias
Haloperidol
How the Drug Works
- Dopamine receptor antagonist with greater action at D2 receptors. Also blocks alpha-2 adrenergic receptors
Haloperidol
How Long Until It Works
- Psychosis – usually within a week
- GTS – weeks to months
Haloperidol
If It Works
- Use at lowest effective dose
- Monitor QT corrected (QTc) interval
- Continue to assess effect of the medication and if it is still needed
Haloperidol
If It Doesn’t Work
- Psychosis: increase dose or change to another agent
- GTS: discontinue or change to another agent
Haloperidol
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Tics and GTS symptoms may change over time. Many patients improve with age. Behavioral and psychological therapy are useful. Education and reassurance are all that is needed in mild cases
- Identify and treat comorbid conditions, such as ADHD or obsessive compulsive disorder
- In GTS, alpha-2 adrenergic agonists such as clonidine and guanfacine, reserpine, and other neuroleptics are also useful
- For intractable migraine, often combined with NSAIDs or dihydroergotamine
- In general, avoid combining with other conventional antipsychotics
Haloperidol
Tests
- Monitor weight, blood pressure, lipids, and fasting glucose with chronic use. Obtain blood pressure and pulse before initial IV use and monitor QTc with ECG
Adverse Effects (AEs)
Haloperidol
How Drug Causes AEs
- Motor AEs and prolactinemia – blocking of D2 receptors
- Hypotension – blocking of alpha-1 adrenergic receptors
Haloperidol
Notable AEs
- Most common: Dizziness, sedation, dry mouth, constipation, weight gain
- Tachycardia, hypotension or hypertension
- Akathisia, parkinsonism
Haloperidol
Life-Threatening or Dangerous AEs
- Tardive dyskinesias
- Neuroleptic malignant syndrome
- Rare neurotoxicity in patients with thyrotoxicosis
Haloperidol
Weight Gain
- Not unusual
Haloperidol
Sedation
- Common
Haloperidol
What to Do About AEs
- Take at night to avoid sedation. For severe AEs, change to another agent
- Rarely causes ECG changes. Use with caution in patients if QTc is above 450 (females) or 440 (males) and do not administer with QTc greater than 500
- If excessive sedation, use only as a rescue agent for intractable migraine in hospitalized patients or when patients can lie down or sleep
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