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):

  • It is effective in treating severe behavioral problems in children with combative, explosive hyperexcitability that cannot be accounted for by immediate provocation.
  • It should only be given to children when there is a failure to respond to psychotherapy or medications other than antipsychotics.

• Hyperactivity (tablet, concentrate):

  • It is indicated in the short-term treatment of hyperactive children who show excessive motor activity with accompanying conduct disorders consisting of some or all of the following symptoms:
    • 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/day per oral based on response and tolerability up to a maximum dose of 10 mg/day.
• Additional data may be necessary to further define the role of haloperidol in this condition.

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

Note: The initial steps to prevent and manage delirium include nonpharmacologic interventions and treatment of underlying conditions. Antipsychotics may be used as short-term adjunctive treatment if distressing symptoms (eg, agitation, anxiety) are present.

• IV (off-label route): Initial:
  • 0.5 to 10 mg depending on the degree of agitation;
  • if inadequate response, may repeat or increase bolus dose every 15 to 30 minutes until calm achieved, then administer 25% of the total bolus dose every 6 hours if needed.
  • Regular monitoring of ECG and QTc interval is required.
  • After symptoms resolve, haloperidol therapy should be tapered off over several days.
  • This strategy is based on expert opinion; efficacy and safety have not been formally evaluated.

Note: In refractory patients, continuous infusions with doses in the range of 0.5 to 40 mg/hour with an optional loading dose of 2.5 mg can be given

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;
  • titrate daily based on response and tolerability up to a maximum of 6 mg per 24 hours.
  • 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: 1.5 to 2.5 mg once or twice daily.
• SubQ: 1 to 2 mg 2 to 3 times a day or as a continuous subcutaneous infusion at 1 to 5 mg per 24 hours.

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

• Initial: 2 mg/day orally;
• adjust dose based on response and tolerability by 2 mg every 3 days up to a maximum dose of 10 mg/day.
• The average dose in the clinical trial was 6 mg/day.
• Additional data may be necessary to further define the role of haloperidol in this condition.

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 oral 2 to 3 times daily;
  • adjust dose based on response and tolerability.
  • For optimal response, daily dosages up to 100 mg may be necessary as per the manufacturer, infrequently, doses >100 mg have been used in severely treatment-resistant patients.
  • Recommended dose range for schizophrenia: 5 to 20 mg/day..

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; subsequent doses may be administered as often as every 60 minutes, although 4- to 8-hour intervals may be satisfactory.
  • maximum: 20 mg/day.
• IM (as decanoate):
• Note:
  • Establish tolerance to oral haloperidol prior to changing to IM decanoate injection.
  • Initial: 10 to 20 times the daily oral dose. The initial dose should not exceed 100 mg regardless of previous antipsychotic requirements. If the initial dose conversion requires >100 mg, administer the dose in 2 injections (maximum of 100 mg for first injection) separated by 3 to 7 days.
• 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 to 15 times the previous daily oral dose or 50 to 200 mg.
  • Administer doses at 4-week intervals; adjust dose based on response and tolerability.
• Oral overlap:
  • Following the initial dose, taper the oral dose and discontinue following the subsequent 2 or 3 injections (ie, 60 to 90 days).
  • Alter the rate of taper based on clinical response and presence of adverse events.

• Alternative dosing regimen:

  • Loading dose regimen:
    • Initial: 20 times the previous daily oral dose, divide the total dose and give every 3 to 7 days, do not exceed 250 mg per injection, oral haloperidol should be stopped before the first injection.
    • Reduce the dose by 25% each month, depending on clinical response, in months 2 to 4, and establish the maintenance dose.
  • Usual maintenance dose:
    • 200 mg per month.

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

• Oral: 0.5 to 5 mg 2 to 3 times daily; adjust dose based on response and tolerability.
• Tourette Canada Guidelines recommend a dosing range of 0.5 to 3 mg/day and the European Society for the Study of Tourette Syndrome recommends a dosing range of 0.25 to 15 mg/day.
• For optimal response, daily dosages up to 100 mg may be necessary in some cases as per the manufacturer, infrequently doses >100 mg have been used in severely treatment-resistant patients.

• Dosing Conversion:

  • IM (as lactate) to oral:
    • Use the total IM (as lactate) dose administered in the preceding 24 hours as an initial approximation of the total daily dose required for the oral formulation.
    • The first oral dose should be started within 12 to 24 hours of the last IM (as lactate) dose.
    • Adjust dose based on response and tolerability.
  • Oral to IM (as decanoate):
    • See schizophrenia dosing.

• Discontinuation of therapy:

  • In order to avoid withdrawal symptoms (ie, insomnia, headache, and GI symptoms), a gradual dose reduction should be done unless discontinuation is due to significant adverse effects.
  • The dose should be gradually reduced over months to years with close monitoring when discontinuing chronic antipsychotic therapy in patients with schizophrenia or bipolar disorder to allow for the detection of prodromal symptoms of disease recurrence.

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

  • Strategies include cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic) and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose).
  • The current medication may be maintained at full dose as the new medication is increased (ie, overlap); once the new medication is at the therapeutic dose, the first medication is gradually decreased and discontinued over 1 to 2 weeks in patients with schizophrenia having a high risk of relapse.
  • Based on clinical experience, some experts generally prefer cross-titration and overlap approaches rather than abrupt change.

Haloperidol (Haldol) dose in children:

Note:

• Dosing should be individualized based on patient response.
• Gradually decrease dose to the lowest effective maintenance dosage once a satisfactory therapeutic response is obtained.

Note: Dosing presented as fixed (mg) dosing and weight-based (mg/kg) dosing; use caution when prescribing and dispensing.

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

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

  • Oral: Initial: 0.5 mg/day in 2 to 3 divided doses; may increase by 0.5 mg every 5 to 7 days to usual maintenance range 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;
  • The maximum dose not established; children with severe, nonpsychotic disturbances may require higher doses; however, no improvement has been shown with doses >6 mg/day.

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

  • Oral: 0.5 to 15 mg/day in 2 to 3 divided doses; begin at the lower end of the range and may increase as needed (no more frequently than every 5 to 7 days).
  • maximum daily dose: 15 mg/day.
  • Note: Higher doses may be necessary in severe or refractory cases.

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

Note: Reported experience in infants is very limited and suggests that lower doses may be required.

• 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.
  • a retrospective review of 27 patients (ages: 3 months to 17 years) using this dosing showed the signs/symptoms of delirium responded well to treatment in all patients; however, two patients experienced dystonic reactions.
  • In a small case-series, loading doses of 0.025 to 0.1 mg/kg/dose administered every 10 minutes until sedation achieved (reported total haloperidol loading dose: 0.09 to 0.25 mg/kg total) followed by maintenance doses of 0.06 to 0.45 mg/kg/day in divided doses every 6 to 8 hours were described (n=5; age range: 9 months to 16 years);
  • infants (n=2) were noted to require lower doses (total loading dose: 0.09 to 0.1 mg/kg total; maintenance: 0.015 to 0.025 mg/kg/dose every 6 hours); one patient experienced a dystonic reaction.

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 2 to 3 divided doses;
  • Increase by 0.5 mg every 5 to 7 days to usual maintenance range of 0.05 to 0.15 mg/kg/day in 2 to 3 divided doses (maintenance range calculates to a fixed dose of 0.75 to 6 mg/day in divided doses);
  • Higher doses may be necessary in severe or refractory cases;
  • maximum dose not established;
  • in adolescents, the maximum daily dose is 15 mg/day.

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

  • 0.5 to 15 mg/day per oral in 2 to 3 divided doses;
  • begin at the lower end of the range and may increase as needed (no more frequently than every 5 to 7 days).
  • maximum daily dose: 15 mg/day.
  • Note: Higher doses may be necessary in severe or refractory cases.

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:

  • 0.01 mg/kg/dose  per oral 3 times daily as needed;
  • To manage new-onset acute episode: 0.025 to 0.05 mg/kg once then may repeat 0.025 mg/kg/dose in one hour 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 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 not established; however, no improvement has been shown with doses >6 mg/day in patients with nonpsychotic disturbances
  • Alternate dosing: Limited data available:
    • Initial: 0.25 to 0.5 mg/day per oral in 2 to 3 divided doses titrated to a usual daily dose range of 1 to 4 mg/day.

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

  • 0.25 to 15 mg/day per oral in 2 to 3 divided doses;
  • begin at the lower end of the range and may increase as needed (no more frequently than every 5 to 7 days)
  • The usual dose range: 1 to 4 mg/day, maximum dose not established; however, no improvement has been shown with doses >6 mg/day in patients with nonpsychotic disturbances.

• Discontinuation of psychosis therapy:

  • Children and Adolescents:

    • The manufacturer and 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) guidelines recommend that in order to avoid withdrawal symptoms and minimize the risk of relapse, drugs should be gradually tapered.
    • The risk for withdrawal symptoms may be highest with highly anticholinergic or dopaminergic antipsychotics.
    • The CPA guidelines recommend a gradual taper over 6 to 24 months and the APA guidelines recommend reducing the dose by 10% each month when stopping antipsychotic therapy in patients with schizophrenia.
    • Withdrawal symptoms can be prevented by continuing anti-parkinsonism agents for a brief period after discontinuation.
    • When switching antipsychotics, three strategies have been suggested:
      • Cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose).
    • Evidence supporting ideal switch strategies and taper rates is limited and results are conflicting.

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 with electrolyte disorders (eg, hypokalemia or hypomagnesemia), hypothyroidism and familial long QT syndrome are more at risk for adverse effects.
  • Before starting therapy, it is important to have a baseline ECG.
  • If the patient is at risk for QTc prolongation due to certain factors, the baseline ECG should reveal a prolonged QTc or cumulative doses exceeding 2 mg.
  • A continuous monitoring of ECG may be necessary.
  • During therapy, electrolyte levels should be monitored.
  • If the QTc interval is increased by 20% to 25%, >500 msec or if there are T-waves flattening or U-waves on the ECG, dosis reduction or alternative therapy should be considered.

• Anticholinergic effects

  • Haloperidol therapy can cause anticholinergic effects such as constipation, xerostomia and blurred vision.
  • Patients with reduced gastrointestinal motility, paralytic and ileus, urinary retentions, BPH, xerostomia or visual problems are at greater 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

  • Antipsychotics can be used to treat myelosuppression, which may include leukopenia and neutropenia (sometimes fatal).
  • Preexisting low WBC, or history of drug-induced neutropenia can increase the risk. Therefore, periodic and urgent blood count assessments are necessary.
  • 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.
  • However, it is not known if hyperprolactinemia occurs in patients with breast or other prolactin-dependent cancers.

• Hypersensitivity

  • It can cause hypersensitivity, including anaphylactic reactions and exfoliative dermatologtitis.

• 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.
  • Haloperidol has a lower risk of orthostatic hypotension than other neuroleptics.

• 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

  • Patients with bipolar disorder may experience rapid mood swings to depression when mania control is used. This should be treated with extreme caution.
  • 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.
  • These patients are more sensitive to antipsychotic medication and may experience severe extrapyramidal symptoms, confusion, and falls.

• 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

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Acetylcholinesterase Inhibitors (Central)	May enhance the neurotoxic (central) effect of Antipsychotic Agents. Severe extrapyramidal symptoms have occurred in some patients.
Alcohol (Ethyl)	CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl).
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Amifampridine	Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine.
Amphetamines	Antipsychotic Agents may diminish the stimulatory effect of Amphetamines.
Anticholinergic Agents	May enhance the adverse/toxic effect of other Anticholinergic Agents.
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Botulinum Toxin-Containing Products	May enhance the anticholinergic effect of Anticholinergic Agents.
Brexanolone	CNS Depressants may enhance the CNS depressant effect of Brexanolone.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
CarBAMazepine	May decrease the serum concentration of Haloperidol.
Chloral Betaine	May enhance the adverse/toxic effect of Anticholinergic Agents.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
CloBAZam	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
CNS Depressants	May enhance the adverse/toxic effect of other CNS Depressants.
CYP2D6 Inhibitors (Moderate)	May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Deutetrabenazine	May enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Doxylamine	May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Duvelisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Erdafitinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
FLUoxetine	May enhance the QTc-prolonging effect of Haloperidol. FLUoxetine may increase the serum concentration of Haloperidol.
FluvoxaMINE	May increase the serum concentration of Haloperidol. Management: Monitor for increased haloperidol concentrations/effects when patients are receiving fluvoxamine, particularly when fluvoxamine dose is 150 mg/day or greater.
Fosaprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fosnetupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Guanethidine	Antipsychotic Agents may diminish the therapeutic effect of Guanethidine.
HydrOXYzine	May enhance the CNS depressant effect of CNS Depressants.
Imatinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Itopride	Anticholinergic Agents may diminish the therapeutic effect of Itopride.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Larotrectinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Lithium	May enhance the neurotoxic effect of Antipsychotic Agents. Lithium may decrease the serum concentration of Antipsychotic Agents. Specifically noted with chlorpromazine.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Lumefantrine	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
Methylphenidate	Antipsychotic Agents may enhance the adverse/toxic effect of Methylphenidate. Methylphenidate may enhance the adverse/toxic effect of Antipsychotic Agents.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
MetyroSINE	May enhance the adverse/toxic effect of Antipsychotic Agents.
Mianserin	May enhance the anticholinergic effect of Anticholinergic Agents.
Minocycline	May enhance the CNS depressant effect of CNS Depressants.
Mirabegron	Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.
Mirtazapine	CNS Depressants may enhance the CNS depressant effect of Mirtazapine.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Nitroglycerin	Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.
Nonsteroidal Anti-Inflammatory Agents	May enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion.
Ondansetron	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Panobinostat	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Peginterferon Alfa-2b	May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Pentamidine (Systemic)	Haloperidol may enhance the QTc-prolonging effect of Pentamidine (Systemic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Perhexiline	CYP2D6 Substrates (High risk with Inhibitors) may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
QT-prolonging Agents (Indeterminate Risk - Avoid)	May enhance the QTc-prolonging effect of Haloperidol.
QT-prolonging Agents (Indeterminate Risk - Caution)	May enhance the QTc-prolonging effect of Haloperidol.
QT-prolonging Antidepressants (Moderate Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Antipsychotics (Moderate Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Exceptions: Pimozide.
QT-prolonging Class IC Antiarrhythmics (Moderate Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Kinase Inhibitors (Moderate Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Miscellaneous Agents (Moderate Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Exceptions: Domperidone.
QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Quinolone Antibiotics (Moderate Risk)	Haloperidol may enhance the QTcprolonging effect of QT-prolonging Quinolone Antibiotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Quinagolide	Antipsychotic Agents may diminish the therapeutic effect of Quinagolide.
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Serotonin Modulators	May enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline.
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Simeprevir	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Tetrabenazine	May enhance the adverse/toxic effect of Antipsychotic Agents.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Tobacco (Smoked)	May decrease the serum concentration of Haloperidol.
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
Trimeprazine	May enhance the CNS depressant effect of CNS Depressants.
Urea Cycle Disorder Agents	Haloperidol may diminish the therapeutic effect of Urea Cycle Disorder Agents. More specifically, Haloperidol may increase plasma ammonia concentrations and thereby increase the doses of Urea Cycle Disorder Agents needed to maintain concentrations in the target range.
Risk Factor D (Consider therapy modification)
Abiraterone Acetate	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity.
Amiodarone	May enhance the QTc-prolonging effect of Haloperidol. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Anti-Parkinson Agents (Dopamine Agonist)	May diminish the therapeutic effect of Antipsychotic Agents (First Generation [Typical]). Antipsychotic Agents (First Generation [Typical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Management: Avoid concomitant therapy if possible and monitor for decreased effects of both agents when these combinations cannot be avoided. Atypical antipsychotics such as clozapine and quetiapine may be less likely to reduce the effects of anti-Parkinson agents.
ARIPiprazole	May enhance the QTc-prolonging effect of Haloperidol. ARIPiprazole may diminish the therapeutic effect of Haloperidol. Haloperidol may increase the serum concentration of ARIPiprazole. Management: See full interaction monograph. Aripiprazole dose adjustment may not be required when used as adjunctive therapy for major depressive disorder.
Asunaprevir	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine patches (Butrans brand) at 5 mcg/hr in adults when used with other CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
CYP2D6 Inhibitors (Strong)	May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).
CYP3A4 Inducers (Strong)	May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Inhibitors (Strong)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Dacomitinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index.
Domperidone	Haloperidol may enhance the QTc-prolonging effect of Domperidone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Glycopyrrolate (Systemic)	May decrease the serum concentration of Haloperidol. Management: Monitor patients closely for signs/symptoms of reduced clinical response to haloperidol if concurrent use with glycopyrrolate is required. When possible, consider avoiding concurrent use.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Mequitazine	Antipsychotic Agents may enhance the arrhythmogenic effect of Mequitazine. Management: Consider alternatives to one of these agents when possible. While this combination is not specifically contraindicated, mequitazine labeling describes this combination as discouraged.
Methadone	Haloperidol may enhance the CNS depressant effect of Methadone. Haloperidol may enhance the QTc-prolonging effect of Methadone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation or those taking IV haloperidol may be at even higher risk.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
MiFEPRIStone	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pitolisant	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
QT-prolonging Class IA Antiarrhythmics (Highest Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Class III Antiarrhythmics (Highest Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Kinase Inhibitors (Highest Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Miscellaneous Agents (Highest Risk)	May enhance the QTc-prolonging effect of Haloperidol. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
St John's Wort	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Stiripentol	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Amisulpride	Antipsychotic Agents may enhance the adverse/toxic effect of Amisulpride. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromopride	May enhance the adverse/toxic effect of Antipsychotic Agents.
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Conivaptan	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
Fusidic Acid (Systemic)	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Glycopyrrolate (Oral Inhalation)	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May enhance the anticholinergic effect of Anticholinergic Agents.
Idelalisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Ipratropium (Oral Inhalation)	May enhance the anticholinergic effect of Anticholinergic Agents.
Levosulpiride	Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.
Metoclopramide	May enhance the adverse/toxic effect of Antipsychotic Agents.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxatomide	May enhance the anticholinergic effect of Anticholinergic Agents.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Pimozide	May enhance the QTc-prolonging effect of Haloperidol.
Piribedil	Antipsychotic Agents may diminish the therapeutic effect of Piribedil. Piribedil may diminish the therapeutic effect of Antipsychotic Agents. Management: Use of piribedil with antiemetic neuroleptics is contraindicated, and use with antipsychotic neuroleptics, except for clozapine, is not recommended.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Saquinavir	May enhance the QTc-prolonging effect of Haloperidol.
Sulpiride	Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.
Umeclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.

 

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)
• Tardive dyskinesia occurs every 6 months, high-risk patients every three months).
• Ask about visual changes every year
• Ocular examination: Annually for patients over 40 years old; once every two years for younger patients
• ICU delirium
  • Monitor the Confusion Assessment Method (CAM-ICU), or the Intensive Care Delirium Screening Checklist.

How to administer Haloperidol (Haldol)?

Injection oil (decanoate).

• The injectable decanoate formulation should only be administered IM. It should not be administered via IV..
• It is recommended to use a 21-gauge needle.
• Maximum volume for injection sites should not exceed 3 ml
• Z-track injection techniques can be used to reduce leakage following injections.
• Although experts recommend deep IM injections to the gluteal muscles, it has been proven that haloperidol can be administered by deltoid injection.

Injection solution (lactate).

• The lactate injectable formula can be administered IV or IM (off-label route).
• It is not clear what the rate of IV administration should be; reports have reported rates as high as 5 mg/minute or 0.125 mg/kg in a matter of minutes.

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:

• Occurs in liver 50% to 60% glucuronidation (inactive);
• 23% CYP3A4-mediated reduction to inactive metabolites (some back-oxidation to haloperidol); and 20% to 30% CYP3A4-mediated N-dealkylation, including minor oxidation pathway to toxic pyridinium derivative.

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:

Haloperidol Injection 5 Mg in Pakistan
Cara-Dol	Caraway Pharmaceuticals

 

Haloperidol Injection 5 Mg/Ml in Pakistan
Gendol	Genetics Pharmaceuticals
Halodol	Pharmedic (Pvt) Ltd.
Medinac	Mediceena Pharma (Pvt) Ltd.
Medinac	Mediceena Pharma (Pvt) Ltd.
Serenace	Searle Pakistan (Pvt.) Ltd.

 

Haloperidol Injection 50 Mg/Ml in Pakistan
Seredol Injection	Genetics Pharmaceuticals

 

Haloperidol Injection 100 Mg/Ml in Pakistan
Seredol Injection	Genetics Pharmaceuticals

 

Haloperidol Drops 2 Mg/Ml in Pakistan
Serenace	Searle Pakistan (Pvt.) Ltd.

 

Haloperidol Liquid 2 Mg/Ml in Pakistan
Dosik	Adamjee Pharmaceuticals (Pvt) Ltd.
Halpol	Xenon Pharmaceuticals (Pvt) Ltd.

 

Haloperidol Tablets 5 Mg in Pakistan
Cara-Dol	Caraway Pharmaceuticals
Dosik	Adamjee Pharmaceuticals (Pvt) Ltd.
Haldol	Tagma Pharma (Pvt) Ltd.
Halodol	Pharmedic (Pvt) Ltd.
Halodol	Pharmedic (Pvt) Ltd.
Medinac	Mediceena Pharma (Pvt) Ltd.
Phrenia	Pharmedic (Pvt) Ltd.
Phrenia	Pharmedic (Pvt) Ltd.
Sera	Glitz Pharma
Seredol Tablet	Reko Pharmacal (Pvt) Ltd.
Serenace	Searle Pakistan (Pvt.) Ltd.
Serenace	Searle Pakistan (Pvt.) Ltd.

 

Haloperidol Tablets 10 Mg in Pakistan
Dosik	Adamjee Pharmaceuticals (Pvt) Ltd.
Seredol Tablet	Reko Pharmacal (Pvt) Ltd.
Serenace	Searle Pakistan (Pvt.) Ltd.

 

Haloperidol Tablets 1.5 Mg in Pakistan
Dosik	Adamjee Pharmaceuticals (Pvt) Ltd.
Halodol	Pharmedic (Pvt) Ltd.
Phrenia	Pharmedic (Pvt) Ltd.
Sera	Glitz Pharma
Seredol Tablet	Reko Pharmacal (Pvt) Ltd.
Serenace	Searle Pakistan (Pvt.) Ltd.

 

Haloperidol Tablets 0.25 Mg in Pakistan
Serenace	Searle Pakistan (Pvt.) Ltd.