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Typical Antipsychotic (Butyrophenone) Pregnancy: C

Haloperidol (Delirium)

Brand names: Haldol, Serenace

Adult dose

Dose: 0.5–1 mg oral/IM; repeat after 30–60 min if needed (max 3 mg/24h in elderly)
Route: oral, IM, IV (off-label)
Frequency: every 30–60 min PRN, then regular low-dose (0.5 mg BD)
Max: 3 mg/24h (elderly delirium); 5–10 mg/day in non-elderly
MHRA: not licensed for dementia-related psychosis; delirium treatment: low-dose short-term; avoid in Parkinson's disease and Lewy body dementia (severe EPS/neuroleptic sensitivity)

Paediatric dose

Dose: 0.025 mg/kg
Route: oral or IM
Frequency: two to three times daily
Max: 0.15 mg/kg/day
Concentration: 2 mg/mL oral liquid or 5 mg/mL injection mg/ml
Specialist use only for acute agitation ≥12 years; avoid in children <12 for delirium

Dose adjustments

Renal

Reduce dose in severe renal impairment

Hepatic

Reduce dose in hepatic impairment; haloperidol metabolised hepatically

Paediatric weight-based calculator

Specialist use only for acute agitation ≥12 years; avoid in children <12 for delirium

Clinical pearls

  • Lewy body dementia: NEVER use — neuroleptic sensitivity causes severe EPS/coma/death in up to 50% of Lewy body patients
  • HOPE-ICU trial: haloperidol did not reduce delirium duration vs. placebo — non-pharmacological approaches first
  • Falls risk critical in elderly — assess before prescribing

Contraindications

  • Parkinson's disease
  • Lewy body dementia (FATAL neuroleptic sensitivity)
  • QTc >500 ms
  • Parkinsonism
  • Concurrent QT-prolonging drugs

Side effects

  • Extrapyramidal effects (acute dystonia, akathisia, Parkinsonism, tardive dyskinesia)
  • QT prolongation/Torsades de Pointes
  • Sedation
  • Neuroleptic malignant syndrome
  • Falls

Interactions

  • QT-prolonging drugs (absolute caution)
  • Lithium (neurotoxicity)
  • Antiparkinson drugs (reduced effect)
  • Alcohol/CNS depressants (additive)

Monitoring

  • ECG (QTc before and during)
  • EPS assessment (AIMS scale)
  • Metabolic parameters
  • Lewy body dementia exclusion

Reference: BNFc; BNF 86; NICE NG212 (delirium); HOPE-ICU trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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