Haloperidol

General

• Type: Antipsychotic, first generation
• Dosage Forms: PO, IM, IV
• Common Trade Names: Haldol

Adult Dosing

• Acute Agitation:
  • 5-10mg IM, subsequent doses based on patient response dosed every 1 hour
  • 0.5-10mg IV, depending on degree of agitation; may repeat bolus dose (with sequential doubling of initial bolus dose) q15-30mins until calm achieved

• Psychosis:
  • 0.5-2mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day

• Tourette Syndrome:
  • 0.5-2mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day

• Agitation
  • 0.5-10mg PO q1-4hrs, Max 100mg/day

Pediatric Dosing

• Acute Agitation:
  • Injectable safety and effectiveness not established in pediatric patients <12yo

• Psychosis:
  • 3-12yo - 0.05-0.15mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day
  • >12 - 0.5mg-2mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day

• Tourette Syndrome:
  • 3-12yo - 0.05-0.075mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day
  • >12 - 0.5mg-5mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day

• Behavioral Disorders:
  • 3-12yo - 0.05-0.075mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day
  • >12 - 0.5mg-5mg PO divided BID-TID, slowly titrate q7days to effect with Max 100mg/day

• Agitation:
  • 3-12yo - 0.01-0.03mg/kg/day PO divided BID-TID, slowly titrate q7days to effect with Max 0.15mg/kg/day
  • >12 - 0.5mg-10mg PO divided BID-TID, Max 100mg/day

Special Populations

• Pregnancy Rating: C
• Lactation risk: Unknown
• Renal Dosing
  • Adult - none
  • Pediatric - none
• Hepatic Dosing
  • Adult - Hepatic impairment
  • Pediatric - Hepatic impairment

Contraindications

• Allergy to class/drug
• Parkinson's Disease

Adverse Reactions

Serious

• Prolonged QT → Torsades de pointes → Sudden Death
• Hypotension
• Neuroleptic malignant syndrome
• Seizure

Common

• Constipation
• Xerostomia
• Blurred vision
• Urinary retention
• Leukopenia
• Neutropenia
• Agranulocytosis
• Dystonia/Extrapyramidal Disease
• Blurred Vision

Pharmacology

• Half-life: 18 hours
• Metabolism: Hepatic - Glucuronidation and CYP3A4-mediated
• Excretion: Urine and Fecal
• Mechanism of Action: blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain, depressing depresses the release of hypothalamic and hypophyseal hormones leading to a depressed reticular activating system

References

Authors

Andy Gausepohl, Ross Donaldson, Michael Holtz, Daniel Ostermayer