Professional view

haloperidol: prescribing and clinical use

Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.

haloperidol: clinical details

Prescribing considerations

Confirm that the indication and patient age are covered by the specific formulation's licence.
Review cardiac, neurological, hepatic, renal, seizure, endocrine, thromboembolic and falls risks, plus interacting medicines.
Frail older patients are more susceptible to extrapyramidal effects, dysphagia, aspiration, hypotension, falls, cardiac events and increased mortality.
Avoid abrupt withdrawal where possible.

Contraindications and cautions

Hypersensitivity, coma or significant 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 or concomitant use of a medicine known to prolong the QT interval.

Monitoring

Assess ECG need before treatment; baseline ECG is recommended before intramuscular administration and in patients with cardiovascular risk factors.
Correct potassium or magnesium disturbances and consider subsequent electrolyte monitoring.
Monitor blood pressure, sedation, movement symptoms, swallowing difficulty and falls risk.
Consider prolactin-related symptoms, weight, liver function and mental-state changes according to clinical circumstances.

Clinical pharmacology

A potent central dopamine D2 antagonist with low alpha-1 adrenergic activity and little intrinsic antihistaminic or anticholinergic activity. It is extensively metabolised by the liver, including through CYP3A4 and CYP2D6.

Formulation and product differences

Oral solutions vary substantially in concentration; substitution can cause measurement errors unless the prescribed volume is recalculated and clearly communicated.
Halkid is supplied with an oral syringe and may be diluted only with water immediately before administration.
Selected short-acting injections are for intramuscular use by healthcare professionals; paediatric safety and efficacy are not established for these products.
Licensed indications differ between injection products.

Haloperidol 5mg/ml Solution for Injection — Current selected SmPC Halkid 200mcg/ml Oral Solution — Current selected SmPC Haloperidol Injection BP 5mg/ml — Current selected SmPC Haloperidol Oral Solution BP 5 mg/5 ml — Current selected SmPC Haloperidol Oral Solution BP 10 mg/5 ml — Current selected SmPC UK Government

haloperidol preparations and strengths

Oral solution

Route: Oral

Strengths: 200 micrograms/mL, 1 mg/mL, 2 mg/mL, 5 mg/5 mL, 10 mg/5 mL

Halkid 200mcg/ml Oral Solution — Current selected SmPC HALDOL 2 mg/ml Oral Solution — Current selected SmPC Haloperidol 1mg/ml Oral Solution — Current selected SmPC Haloperidol Oral Solution BP 5 mg/5 ml — Current selected SmPC Haloperidol Oral Solution BP 10 mg/5 ml — Current selected SmPC

haloperidol interactions

Check all prescribed, over-the-counter and herbal products. Important examples include:

Medicines that prolong the QT interval

Some antiarrhythmics, antibiotics, antidepressants, antipsychotics and methadone can increase the risk of dangerous cardiac rhythms; listed combinations are contraindicated.

Haloperidol Oral Solution BP 5 mg/5 ml — Current selected SmPC