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haloperidol
Haldol · Haldol Decanoate (LAI)
First-generation antipsychotic⚠ Unverified beta content
At a glance
- Class
- Typical antipsychotic (butyrophenone; high potency)
- Black box
- ⚠ Increased mortality in elderly patients with dementia-related psychosis
- Key monitoring
- ECG / QTc — Notify provider if QTc >500 ms or increase >60 ms from baseline (commonly used threshold)
- EPS / akathisia / dystonia
- Usual adult dose
- Oral – moderate symptoms: 0.5–2 mg BID–TID
- Call provider / escalate if
- Sudden muscle spasm of neck/eyes/jaw/tongue, trouble breathing or swallowing (acute dystonia) • Fainting, palpitations, irregular heartbeat (QT/torsades) • High fever, rigidity, confusion, sweating (NMS)
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- haloperidol (Haldol, Haldol Decanoate (LAI)) — typical antipsychotic (butyrophenone; high potency).
- Used for: Schizophrenia; Tourette’s disorder; Acute agitation in psychosis.
Usual adult dosing
- Oral – moderate symptoms: 0.5–2 mg BID–TID
- Oral – severe / chronic: 3–5 mg BID–TID; usual max ~30 mg/day (Higher doses are rarely used; increased EPS/QT risk.)
- IM (lactate) – acute agitation: 2–5 mg IM; may repeat every 4–8 h as ordered (up to q1h used in some acute settings)
- Decanoate (LAI): Monthly; initial 10–20× daily oral dose (max 100 mg first injection)
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
Monitor
- ECG / QTc — Notify provider if QTc >500 ms or increase >60 ms from baseline (commonly used threshold) [Baseline; after dose increases; continuous telemetry if IV]
- EPS / akathisia / dystonia [Every contact; AIMS ≥ every 6–12 months]
Nursing priorities
- Baseline ECG/QTc, K, Mg (esp. IV or high dose or other QT drugs).
- Baseline AIMS/EPS exam, vitals, mental status.
- Have anticholinergic (benztropine) or diphenhydramine available per order for acute dystonia.
- Monitor vitals, sedation, and EPS after IM doses; cardiac monitoring if IV.
- Correct low K/Mg before and during use.
Major interactions
- QT-prolonging drugs (ondansetron, methadone, macrolides, fluoroquinolones, other antipsychotics, citalopram, antiarrhythmics): Additive QT prolongation / torsades.
- Lithium: Rare severe neurotoxicity/EPS/encephalopathy – monitor.
Key teaching
- Tell staff right away if your neck, jaw, or eyes suddenly tighten or twist, or if you can’t stay still – these can be treated quickly.
- You may feel stiff, shaky, or restless; this can be treated.
- Rise slowly from lying or sitting.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
Other serious warnings
- QT prolongation, torsades de pointes and sudden death – higher risk with IV use and high doses
- NMS
- Tardive dyskinesia
- Acute dystonia incl. laryngeal dystonia
- Seizure-threshold lowering
- Hyperprolactinemia
- Leukopenia/neutropenia/agranulocytosis (rare)
- Orthostatic hypotension
- Neurotoxicity with lithium (rare)
- Dysphagia
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
- ECG / QTcTarget: Notify provider if QTc >500 ms or increase >60 ms from baseline (commonly used threshold)When: Baseline; after dose increases; continuous telemetry if IV
- Potassium / magnesiumTarget: Within normal range (K ≥4.0, Mg ≥2.0 often targeted)When: Baseline if risk
- EPS / akathisia / dystoniaWhen: Every contact; AIMS ≥ every 6–12 months
- Vitals (temp, BP, HR)NMS, hypotension
- CBCIf infection signs
- Prolactin symptoms
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
Assessment
- Baseline ECG/QTc, K, Mg (esp. IV or high dose or other QT drugs).
- Baseline AIMS/EPS exam, vitals, mental status.
- History of cardiac disease, seizures, Parkinson’s disease.
- Agitation level / need for IM.
Interventions
- Have anticholinergic (benztropine) or diphenhydramine available per order for acute dystonia.
- Monitor vitals, sedation, and EPS after IM doses; cardiac monitoring if IV.
- Correct low K/Mg before and during use.
- Observe for NMS (fever, rigidity, autonomic instability).
- LAI: deep IM, Z-track per policy, max volume per site (usually 3 mL).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Sudden muscle spasm of neck/eyes/jaw/tongue, trouble breathing or swallowing (acute dystonia)
- Fainting, palpitations, irregular heartbeat (QT/torsades)
- High fever, rigidity, confusion, sweating (NMS)
- Severe restlessness (akathisia)
- Involuntary face/tongue movements (TD)
- Seizure
- Sore throat/fever/infection signs
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC] · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- EPS: acute dystonia, parkinsonism, akathisia (high risk)
- Sedation (less than low-potency agents)
- Elevated prolactin
- Orthostatic hypotension (less than low-potency)
- Dry mouth, constipation, urinary retention (mild)
- Tardive dyskinesia with long-term use
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
- QT-prolonging drugs (ondansetron, methadone, macrolides, fluoroquinolones, other antipsychotics, citalopram, antiarrhythmics) MajorAdditive QT prolongation / torsades.
- Lithium MajorRare severe neurotoxicity/EPS/encephalopathy – monitor.
- Carbamazepine, rifampin (CYP3A4 inducers)↓ haloperidol levels.
- CYP2D6/3A4 inhibitors (fluoxetine, paroxetine, ketoconazole)↑ haloperidol levels.
- Levodopa/dopamine agonistsAntagonized; worsens Parkinson’s.
- Alcohol, CNS depressantsAdditive sedation.
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
- Tell staff right away if your neck, jaw, or eyes suddenly tighten or twist, or if you can’t stay still – these can be treated quickly.
- You may feel stiff, shaky, or restless; this can be treated.
- Rise slowly from lying or sitting.
- Avoid alcohol; keep cool and drink fluids.
- Tell your provider about all other medicines, especially heart or antibiotic medicines.
- Report fainting or a racing/irregular heartbeat.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Schizophrenia
- Tourette’s disorder (tics, vocal utterances)
- Acute agitation in psychosis (IM)
- Common off-label: delirium agitation, acute agitation (often with lorazepam ± diphenhydramine)
Dosing
- Oral – moderate symptoms: 0.5–2 mg BID–TID
- Oral – severe / chronic: 3–5 mg BID–TID; usual max ~30 mg/dayHigher doses are rarely used; increased EPS/QT risk.
- IM (lactate) – acute agitation: 2–5 mg IM; may repeat every 4–8 h as ordered (up to q1h used in some acute settings)
- Decanoate (LAI): Monthly; initial 10–20× daily oral dose (max 100 mg first injection)
- IV administration: NOT FDA-approvedFacility-specific off-label use; requires ECG/QTc monitoring.
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
Prescriber-oriented details; limited in this beta.
titration
- LAI conversion: 10–20× daily oral dose; initial max 100 mg.
cyp Notes
- CYP3A4 and 2D6 substrate; CYP2D6 inhibitor (moderate).
Sources: FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): HALOPERIDOL TABLET [CARDINAL HEALTH 107, LLC]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- IV haloperidol is off-label in the U.S.; facility policy (QTc thresholds, telemetry) governs.
- QTc >500 ms/ >60 ms increase is a commonly used action threshold, not a label figure – verify with facility policy.