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Typical antipsychotic (butyrophenone) Pregnancy: Moderate data (>400 outcomes) indicate no malformative or foeto/neonatal toxicity; as a precautionary measure, preferable to avoid use during pregnancy. Third-trimester exposure risks extrapyramidal/withdrawal symptoms in the newborn — monitor. Excreted in human milk.

Haloperidol

Brand names: Haldol, Serenace

Used in: Delirium & Cognitive Impairment

Haloperidol is a first-generation (typical) butyrophenone antipsychotic used for schizophrenia, mania, and acute psychomotor agitation and, in some settings, for nausea and palliative care.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2 to 10 mg/day (schizophrenia and schizoaffective disorder)
Route: Oral
Frequency: As a single dose or in 2 divided doses; adjustments may be made every 1 to 7 days
Max: 20 mg/day (schizophrenia); doses above 10 mg/day have not shown superior efficacy and may increase extrapyramidal symptoms
A low initial dose is recommended, adjusted according to response; maintain on minimal effective dose. First-episode schizophrenia generally responds to 2-4 mg/day. Other oral indications (per UK SPC, adults 18+): acute delirium 1-10 mg/day (max 10 mg/day); moderate-to-severe manic episodes bipolar I 2-10 mg/day (max 15 mg/day); acute psychomotor agitation 5-10 mg repeated after 12 h if needed (max 20 mg/day); persistent aggression/psychotic symptoms in moderate-to-severe Alzheimer's/vascular dementia 0.5-5 mg/day (reassess after max 6 weeks); tic disorders/Tourette's 0.5-5 mg/day; mild-to-moderate chorea in Huntington's 2-10 mg/day. Elderly: 0.5 mg/day (dementia indication) or half the lowest adult dose for other indications; max 5 mg/day. Renal impairment: no dose adjustment recommended but caution; severe renal impairment may need lower initial dose. Hepatic impairment: halve the initial dose. Paediatric (schizophrenia in adolescents 13-17 years when other treatments failed/not tolerated): 0.5 to 3 mg/day orally in divided doses (2-3 times a day), max 5 mg/day.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Comatose state; central nervous system (CNS) depression
  • Parkinson's disease; Dementia with Lewy bodies; Progressive supranuclear palsy
  • Known QTc interval prolongation or congenital long QT syndrome
  • Recent acute myocardial infarction; uncompensated heart failure; history of ventricular arrhythmia or torsades de pointes
  • Uncorrected hypokalaemia; concomitant treatment with medicinal products that prolong the QT interval

Side effects

  • Extrapyramidal disorder (very common, 34%)
  • Insomnia (19%); agitation (15%); hyperkinesia (13%); headache (12%)
  • Psychotic disorder, depression, weight increased, tremor, hypertonia, orthostatic hypotension (common)
  • Dystonia, somnolence (common)
  • QTc prolongation and/or ventricular arrhythmias, torsade de pointes, sudden death; tardive dyskinesia; neuroleptic malignant syndrome (uncommon/rare)

Interactions

  • Medicinal products that prolong the QT interval (contraindicated — see 4.3)
  • Poor metabolisers of CYP2D6 may have high plasma concentrations (caution)

Clinical monograph

How it works

It is a potent dopamine D2 receptor antagonist, and reduction of dopaminergic transmission in mesolimbic pathways underlies its antipsychotic effect.

Prescribing in practice

  • Haloperidol prolongs the QT interval and carries a risk of torsade de pointes and sudden death, so perform a baseline ECG, correct electrolytes and avoid combination with other QT-prolonging drugs.
  • It frequently causes extrapyramidal symptoms including acute dystonia, parkinsonism and akathisia, and can cause tardive dyskinesia and neuroleptic malignant syndrome.
  • Use cautiously in the elderly, in whom antipsychotics increase stroke and mortality risk in dementia, and in cardiac, hepatic or Parkinson's disease.

Monitoring

Monitor ECG and electrolytes, extrapyramidal and movement-disorder signs, temperature and mental state, and watch for neuroleptic malignant syndrome.

Counselling the patient

  • Report muscle stiffness, fever, abnormal movements or fainting promptly.
  • Restlessness and stiffness can occur and should be reported so treatment can be adjusted.
  • Avoid alcohol and tell other clinicians about this medicine before new prescriptions.

Evidence & guidelines

MHRA advice highlights the dose-related QT-prolongation and arrhythmia risk of haloperidol, and it remains an established option for psychosis and acute agitation.

Reference: NICE CG178 Psychosis; Maudsley Prescribing Guidelines 14th ed.; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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