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haloperidol

AntipsychoticLAI available

Brands: HALDOL

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

  • What is haloperidol?

    Haloperidol (brand Haldol) is a first-generation (typical) antipsychotic of the butyrophenone class, used for schizophrenia, acute agitation, and maintenance in patients who benefit from high-potency D2 blockade.

  • What is HALDOL?

    HALDOL is a brand name for haloperidol.

  • What is HALDOL (haloperidol) used for?

    Label indications include: Schizophrenia; severe behavior disorders; Tourette's syndrome (tics/vocal utterances); adjunct in acute agitation.

  • What drug class is HALDOL (haloperidol)?

    Antipsychotic.

  • What is the mechanism of action of HALDOL (haloperidol)?

    Potent dopamine D2 receptor antagonist; minimal anticholinergic.

  • What strengths does HALDOL (haloperidol) come in?

    Tablets: 0.5–20 mg; oral solution 2 mg/mL.

  • Is HALDOL (haloperidol) a controlled substance?

    No — it is not scheduled as a controlled substance under U.S. federal law.

  • What is HALDOL (haloperidol) dosing for schizophrenia?

    Schizophrenia (oral): initiate 1–5 mg two or three times daily; maintenance 5–20 mg/day divided; doses >30 mg/day increase EPS risk.

  • How is haloperidol started as a long-acting injectable (LAI)?

    Decanoate LAI: initial total dose 10–20× total daily oral dose; max 100 mg per injection (split remainder 3–7 days later) with short oral overlap as needed; maintenance 50–200 mg IM every 4 weeks.

Snapshot

  • Class: Antipsychotic
  • Common US brands: HALDOL
  • Long-acting injectable formulation available.
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-28

Label indications

Schizophrenia; severe behavior disorders; Tourette's syndrome (tics/vocal utterances); adjunct in acute agitation.

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Clinical Highlights

Haloperidol (brand Haldol) is a first-generation (typical) antipsychotic of the butyrophenone class, used for schizophrenia, acute agitation, and maintenance in patients who benefit from high-potency D2 blockade. This profile emphasizes adult schizophrenia management, acute agitation protocols, and long-acting decanoate maintenance; pediatric and Tourette’s uses fall outside current scope.

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  • Favored for cost, familiarity, and depot availability, but high EPS, tardive dyskinesia, and QTc prolongation risks limit chronic use compared with SGAs.
  • Schizophrenia (adults) (FDA 1967)
  • Acute psychosis and severe behavior disorders (FDA 1967)
  • Generic: All formulations are generic and widely available.
  • The compare tool and evidence library support side-by-side review of depot choices and recent studies; the Schizophrenia hub and LAI Navigator expand on care pathways.

Dosing & Formulations

Tablets: 0.5–20 mg; oral solution 2 mg/mL. Short-acting IM/IV injection: 5 mg/mL lactate formulation.

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  • Long-acting haloperidol decanoate: 25–100 mg/mL IM monthly.
  • Schizophrenia (oral): initiate 1–5 mg two or three times daily; maintenance 5–20 mg/day divided; doses >30 mg/day increase EPS risk.
  • Acute agitation: 2–5 mg IM/IV every 4–8 hours (max 20 mg/day IM); ECG and vital-sign monitoring are commonly used with IV administration.
  • Decanoate LAI: initial total dose 10–20× total daily oral dose; max 100 mg per injection (split remainder 3–7 days later) with short oral overlap as needed; maintenance 50–200 mg IM every 4 weeks.

Monitoring & Risks

Extrapyramidal symptoms are monitored periodically; prophylaxis is generally reserved for clear need. QTc: ECG monitoring is often considered when risk factors or higher doses are present.

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  • LAI: Haloperidol decanoate every 4 weeks—product-specific conversion guidance is typically used.
  • Boxed warning: Increased mortality in elderly patients with dementia-related psychosis (class warning).
  • Extrapyramidal symptoms: Parkinsonism, dystonia, akathisia in >20%, dose-dependent.
  • Tardive dyskinesia: Risk increases with cumulative exposure and age.
  • Akathisia (inner restlessness) can be more distressing than sedation; it often improves with dose adjustment or targeted treatments and is commonly screened for explicitly.

Drug Interactions

CYP3A4 or CYP2D6 inhibitors (ketoconazole, clarithromycin, fluoxetine, paroxetine, quinidine) increase levels—EPS/QT risk can rise and dose reduction may be needed. CYP3A4 inducers (carbamazepine, rifampin) decrease levels—may require higher doses with careful monitoring.

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  • Combinations with other QT-prolonging drugs (class IA/III antiarrhythmics, macrolides, fluoroquinolones) are generally avoided when possible.
  • Additive CNS depression with alcohol, benzodiazepines, opioids.
  • Antagonizes levodopa/dopamine agonists; use is generally avoided in Parkinson’s disease.

Practice Notes

Baseline and periodic ECG monitoring is often considered, especially with IV use or cardiac risk factors. Shared decision-making often includes early follow-up to assess akathisia, stiffness, and adherence before side effects drive nonadherence.

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  • Prophylactic anticholinergic therapy is sometimes used during initiation in high-risk patients for acute dystonia or Parkinsonism.
  • Regular AIMS assessments help track tardive dyskinesia.
  • Decanoate is administered deep IM using Z-track technique; IV administration is avoided.

Long-acting injectable (LAI) options

  • Haloperidol decanoate
    Interval
    q4wk
    Oral overlap
    Consider short overlap during conversion
    Injection site
    Gluteal
    Notes
    • Typical conversion ~10–15× daily oral dose monthly; max first injection 100 mg (split remainder 3–7 days later)
    • Typical effective range 50–200 mg every 4 weeks; individualize

References

  1. HALDOL tablets prescribing information — DailyMed (2025)
  2. HALDOL decanoate prescribing information — DailyMed (2025)
  3. Comparative Efficacy AND Tolerability OF 15 Antipsychotic Drugs IN Schizophrenia: A Multiple Treatments Meta Analysis — The Lancet (2013)Meta-analysisschizophreniaefficacy
  4. Pharmacokinetics of haloperidol: a review — Drug Metabolism Reviews (2012)
  5. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)Guidelineschizophreniaclinical
Haloperidol (HALDOL) — Summary — PsychMed