Haldol (Haloperidol)

Haloperidol is indicated for several psychiatric and neurological conditions where dopamine dysregulation contributes to symptoms.

• Management of schizophrenia, including maintenance therapy.
• Treatment of acute psychotic episodes.
• Control of severe agitation associated with psychiatric disorders.
• Reduction of motor and vocal tics in Tourette syndrome.
• Adjunctive therapy for other severe behavioral disturbances as determined by a clinician.

Haloperidol may cause a range of side effects, some of which are more frequently observed while others are less common but potentially serious.

Common

• Drowsiness or sedation.
• Extrapyramidal symptoms such as tremor, rigidity, or akathisia.
• Dry mouth and constipation.
• Blurred vision.
• Weight gain.
• Orthostatic hypotension.

Serious

• Neuroleptic malignant syndrome.
• Tardive dyskinesia with long‑term use.
• Severe cardiac arrhythmias (QT prolongation).
• Hyperprolactinemia leading to hormonal disturbances.
• Seizures in predisposed individuals.
• Significant worsening of Parkinsonian symptoms.

Before starting haloperidol, clinicians should evaluate several health factors to minimize risks.

• Review patient history for cardiovascular disease, especially arrhythmias.
• Assess for prior movement disorders or Parkinsonian symptoms.
• Monitor for signs of neuroleptic malignant syndrome during early treatment.
• Use caution in patients with hepatic or renal impairment; dose adjustments may be needed.
• Evaluate pregnancy status; the safety profile in pregnancy is not well established.
• Conduct regular ECG monitoring when high doses or concomitant QT‑prolonging drugs are used.
• Educate patients and caregivers about the potential for sudden onset of severe side effects.

Haloperidol can interact with several medication classes, affecting its safety and efficacy.

Avoid

• Other dopamine antagonists or antipsychotics that may increase extrapyramidal risk.
• Medications known to prolong the QT interval (e.g., certain antiarrhythmics, macrolide antibiotics).
• Strong CYP3A4 inhibitors such as ketoconazole, which can raise haloperidol plasma levels.

Use with caution

• CNS depressants including benzodiazepines and opioids, which may enhance sedation.
• Anticholinergic agents that can mask early signs of extrapyramidal symptoms.
• CYP2D6 substrates (e.g., metoprolol) as haloperidol may alter their metabolism.
• Alcohol, which can increase drowsiness and impair coordination.