Haloperidol

HALDOL

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Pronunciation: ha-loe-PER-i-doel

Haloperidol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Haloperidol ballicule

Haloperidol HALDOL mascot mnemonic cartoon — Visual mnemonic: Haloperidol mascot
**“Halo doll”**
Spooky greyscale mascot → high-potency first generation antipsychotic (FGA)
QT prolongation
Bra → may increase prolactin → gynecomastia risk

What it isHigh-potency D2/D3-antagonist antipsychotic; psychosis, delirium-related agitation, and Tourette syndrome.

Why this oneMinimal anticholinergic and metabolic burden, available IM and IV, and long familiarity in acute settings.

What limits itThe highest extrapyramidal and tardive dyskinesia risk of the common agents. QT prolongation, especially IV.

Haloperidol molecular structure (skeletal formula) — Molecular structure: Haloperidol

FDA-approved for

schizophrenia (1967)
Tourette syndrome (~1978)

Off-label

delirium
acute agitation

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Increased mortality in elderly patients with dementia-related psychosis treated with antipsychotics; haloperidol is not approved for dementia-related psychosis.

FDA dosing	Population	Start	Target	Max
Psychotic disorders	Adults	Moderate: 0.5-2 mg BID-TID; severe: 3-5 mg BID-TID	Titrate to response; up to 100 mg/day if needed	Doses >100 mg not established as safe
Psychotic disorders	Geriatric/debilitated or chronic/resistant	0.5-2 mg BID-TID (geriatric/debilitated); 3-5 mg BID-TID (chronic/resistant)	Lowest effective maintenance
Psychotic disorders, nonpsychotic behavior disorders, Tourette's	Children 3-12 yr (15-40 kg)	0.5 mg/day	Psychotic 0.05-0.15 mg/kg/day; nonpsychotic & Tourette's 0.05-0.075 mg/kg/day (divided BID-TID)	Little added benefit >6 mg/day

Titration Children: increase by 0.5 mg at 5-7 day intervals

Renal Undefined

Hepatic Undefined

Instructions

Individualize dose; reduce gradually to lowest effective maintenance level
Withdraw gradually to reduce risk of withdrawal-emergent dyskinesia
Switching from injectable: give first oral dose 12-24 h after last parenteral dose

Available strengths

tab 0.5, 1, 2, 5, 10, 20 mg
sol 2 mg/mL
inj 5 mg/mL

Contraindications

Severe toxic CNS depression or comatose states from any cause
Parkinson's disease

Cautions

Increased mortality in elderly with dementia-related psychosis (boxed)
Tardive dyskinesia / tardive dystonia (may be irreversible)
Neuroleptic malignant syndrome
QT prolongation and Torsades de pointes; sudden death reported
Extrapyramidal symptoms, especially early and at higher doses

Adverse reactions

Extrapyramidal symptoms (parkinsonism, akathisia, dystonia)
Tardive dyskinesia
Sedation, restlessness, insomnia
Tachycardia, hypotension/hypertension, QT prolongation
Dry mouth, blurred vision, urinary retention
Neuroleptic malignant syndrome

Pregnancy Undefined

Lactation Undefined

Cost

Haloperidol (HALDOL)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
0.5 mg	tab	60 BID	$5.14	offered
1 mg	tab	60 BID	$7.17	offered
2 mg	tab	60 BID	$9.95	offered
5 mg	tab	60 BID	$10.84	offered
10 mg	tab	60 BID	$8.79	offered
20 mg	tab	60 BID	$22.27	offered

Other forms: Haloperidol injection (HALDOL IM / IV)

Generic entry1986

⚠ BOXED WARNING

Increased mortality in elderly patients with dementia-related psychosis

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades2 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.

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Memory aids: interaction avatars

CYP2D6 substrate

CYP3A4 substrate

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