haloperidol decanoate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
haloperidol decanoate: clinical details
Prescribing considerations
- Use only in adults previously treated and stabilised with oral haloperidol; initiation and adjustment require close clinical supervision.
- Assess cardiovascular disease, bradycardia, stroke and venous-thromboembolism risks, epilepsy, renal or hepatic impairment, hyperprolactinaemia and susceptibility to extrapyramidal effects.
- Older adults may have higher exposure and greater susceptibility to neurological, cardiovascular and orthostatic adverse effects.
- Not indicated for dementia-related behavioural disturbance.
Contraindications and cautions
- Hypersensitivity to haloperidol or excipients
- Coma or central nervous system depression
- Parkinson’s disease, dementia with Lewy bodies or progressive supranuclear palsy
- Known QTc prolongation, congenital long-QT syndrome, recent myocardial infarction, uncompensated heart failure, previous ventricular arrhythmia or torsades de pointes
- Uncorrected hypokalaemia
- Concomitant medicines known to prolong the QT interval
Monitoring
- Obtain a baseline ECG and assess the need for ongoing ECG monitoring.
- Correct potassium or magnesium disturbances before treatment and monitor electrolytes periodically.
- Assess blood pressure and relevant orthostatic symptoms.
- Monitor for extrapyramidal symptoms, akathisia, tardive dyskinesia and swallowing impairment.
- Review prolactin-related symptoms, seizure risk, liver concerns and venous-thromboembolism risk as clinically indicated.
Clinical pharmacology
Haloperidol decanoate is slowly released from the intramuscular depot and hydrolysed to haloperidol. Active haloperidol is a potent central D2-receptor antagonist, is extensively metabolised in the liver and has prolonged elimination after depot administration.
Formulation and product differences
- Long-acting oily depot containing sesame oil and benzyl alcohol.
- Deep gluteal intramuscular administration only; never intravenous.
- Adverse effects may persist after discontinuation because release from the injection site is prolonged.
haloperidol decanoate preparations and strengths
Injection
Route: Parenteral
Strengths: 50 mg/mL, 100 mg/mL
haloperidol decanoate interactions
Check all prescribed, non-prescribed and herbal products before treatment. Important examples include:
Medicines that prolong the QT interval
Examples include amiodarone, sotalol, citalopram, escitalopram, some macrolide or quinolone antibiotics and methadone. They can increase dangerous heart-rhythm risk and are contraindicated with this product.
CYP3A4 or CYP2D6 inhibitors
Fluoxetine, paroxetine, ritonavir, itraconazole and verapamil can raise haloperidol concentrations and adverse-effect risk.
Enzyme inducers
Carbamazepine, phenytoin, phenobarbital, rifampicin and St John’s wort can lower haloperidol concentrations and reduce effectiveness.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.