Haldol (Haloperidol)

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

• Schizophrenia, including maintenance therapy for chronic disease
• Acute psychotic episodes or severe agitation requiring rapid control
• Manic episodes associated with bipolar disorder when other agents are insufficient
• Tourette syndrome, particularly for patients with disabling motor or vocal tics
• Adjunctive treatment of severe behavioral disturbances in dementia (off‑label in some regions)

Haloperidol may produce a range of adverse effects that vary in frequency and severity.

Common

• Drowsiness or sedation, especially when therapy is initiated
• Extrapyramidal symptoms such as tremor, rigidity, akathisia, or dystonia
• Dry mouth, increased salivation, or changes in taste perception
• Constipation, nausea, or other gastrointestinal discomfort
• Blurred vision, dizziness, or orthostatic light‑headedness

Serious

• Tardive dyskinesia, a potentially irreversible involuntary movement disorder
• Neuroleptic malignant syndrome, with fever, rigidity, autonomic instability, and altered mental status
• Severe hypotension or cardiac arrhythmias, including QT prolongation
• Elevated prolactin levels causing galactorrhea, gynecomastia, or menstrual irregularities
• Agranulocytosis or severe leukopenia, leading to increased infection risk

When prescribing haloperidol, clinicians should evaluate patient history and monitor for conditions that may increase risk of adverse outcomes.

• History of cardiovascular disease, arrhythmias, or prolonged QT interval
• Pre‑existing movement disorders or Parkinsonian features
• Severe hepatic or renal impairment affecting drug clearance
• Pregnancy, breastfeeding, or women of childbearing potential (risk not well defined)
• Elderly patients, especially those with dementia, due to higher sensitivity to sedation and extrapyramidal effects
• Concomitant use of other central nervous system depressants

Haloperidol can interact with several medications, altering its efficacy or increasing the likelihood of serious side effects.

Avoid

• Other potent dopamine antagonists or high‑dose antipsychotics
• Drugs that significantly prolong the QT interval (e.g., certain antiarrhythmics, macrolide antibiotics)
• Strong CYP3A4 inhibitors such as ketoconazole or clarithromycin

Use with caution

• CYP3A4 inducers like carbamazepine or rifampin, which may reduce haloperidol levels
• CNS depressants including benzodiazepines, opioids, or alcohol
• Anticholinergic agents that may mask extrapyramidal symptoms