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Typical antipsychotic (butyrophenone) Pregnancy: Use only if essential. May cause neonatal extrapyramidal effects.

Haloperidol

Brand names: Haldol, Serenace

Adult dose

Dose: Schizophrenia: 1–10 mg twice daily; Acute agitation: 5–10 mg IM; Nausea/delirium: 0.5–2 mg
Route: Oral, IM, or IV
Frequency: Twice daily (oral); as needed (IM/IV acute use)
Max: 30 mg/day oral; 18 mg/day IM (acute); specialist guidance for higher doses
Schizophrenia: start 0.5–3 mg BD, titrate. Acute agitation: 5–10 mg IM. Delirium (palliative): 0.5–2 mg SC/oral. Antiemetic/delirium: 0.5–1 mg BD-TDS. IV haloperidol: unlicensed use for delirium in critical care — under monitoring.

Paediatric dose

Dose: 0.025 mg/kg
Route: Oral or IM
Frequency: Twice or three times daily
Max: 0.1 mg/kg/day (tics/Tourette's); 0.15 mg/kg/day (behavioural)
Concentration: 2 mg/ml
3–12 years (tics/Tourette's): 0.025–0.05 mg/kg/day in 2–3 divided doses. Adolescents: 0.5–3 mg BD. Use lowest effective dose. Regular EPS monitoring essential.

Dose adjustments

Renal

No specific dose adjustment but use with caution; start low.

Hepatic

Reduce dose in hepatic impairment; metabolised hepatically.

Paediatric weight-based calculator

3–12 years (tics/Tourette's): 0.025–0.05 mg/kg/day in 2–3 divided doses. Adolescents: 0.5–3 mg BD. Use lowest effective dose. Regular EPS monitoring essential.

Clinical pearls

  • High EPS risk compared to atypical antipsychotics — offer prophylactic procyclidine/benztropine
  • First choice for acute agitation in emergency settings (with benzodiazepine if needed — TRRAP algorithm)
  • QT prolongation — ECG before use especially in elderly and cardiac patients
  • Haloperidol decanoate (long-acting injection — monthly) for maintenance in non-adherent patients
  • AVOID in Lewy body dementia — potentially fatal hypersensitivity reaction

Contraindications

  • Parkinson's disease (worsening)
  • Lewy body dementia (potentially fatal neuroleptic sensitivity)
  • QT prolongation / Torsades de Pointes history
  • Coma or CNS depression
  • Basal ganglia disease

Side effects

  • Extrapyramidal symptoms (dystonia, parkinsonism, akathisia, tardive dyskinesia)
  • QT prolongation and Torsades de Pointes
  • Sedation
  • Hyperprolactinaemia
  • Neuroleptic Malignant Syndrome (rare — fever, rigidity, autonomic instability)
  • Hypotension
  • Anticholinergic effects (mild compared to phenothiazines)

Interactions

  • Drugs that prolong QT — additive QT prolongation (amiodarone, erythromycin, fluconazole)
  • CNS depressants — additive sedation
  • Lithium — increased neurotoxicity
  • Ritonavir — increases haloperidol levels
  • Anticholinergics — reduced haloperidol efficacy and increased anticholinergic effects

Monitoring

  • ECG (QT interval)
  • EPS symptoms
  • FBC
  • Metabolic monitoring (less than atypicals)
  • AIMS (abnormal involuntary movement scale)

Reference: BNFc; BNF; NICE CG178 Psychosis; Maudsley Prescribing Guidelines 14th ed.. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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