Haloperidol oral

Therapeutic action

Antipsychotic.

Indications

Due to the numerous and potentially severe adverse effects of haloperidol, patients should be kept under close surveillance.

• Acute confusional state (delirium) and acute alcohol intoxication.
• Acute or chronic psychosis.
• Acute manic episode.
• Agitation or aggressive behaviour in patients with acute or chronic psychosis, in combination with promethazine.

Forms and strengths

• 0.5 mg, 1.5 mg, and 5 mg tablets.
• 2 mg/ml oral solution with pipette graduated in mg.

Dose

Reduce the dose by half in older patients, maximum 5 mg daily.

Use the lowest effective dose, especially in prolonged treatment.

Duration

Discontinue treatment gradually over 4 weeks. If signs of relapse occur, increase the dose then decrease it more gradually.

• Delirium and acute alcohol intoxication: as short as possible, maximum 7 days.
• Acute psychosis: at least 3 months.
• Chronic psychosis: at least one year.
• Manic episode: 8 weeks after remission of symptoms.

Contra-indications, adverse effects, precautions

• Do not administer to patients with cardiac disorders, dementia, Parkinson's disease, or a history of neuroleptic malignant syndrome.
• Administer with caution and carefully monitor use in older patients and in patients with hypokalaemia, hypotension, hyperthyroidism, renal or hepatic impairment, or a history of seizures.
• May cause drowsiness, extrapyramidal symptoms, early or tardive dyskinesia, anticholinergic effects, hyperprolactinaemia, weight gain, sexual dysfunction, QT prolongation, ventricular arrhythmia, orthostatic hypotension, and neuroleptic malignant syndrome.
• In case of extrapyramidal symptoms, try reducing the dose or add biperiden or trihexyphenidyl if symptoms are severe.
• Avoid or monitor combination with CNS depressants, fluoxetine, paroxetine, sertraline, ritonavir, carbamazepine, rifampicin, phenobarbital, phenytoin, antihypertensive drugs, and drugs that prolong the QT interval.
• Avoid alcohol during treatment.
• Pregnancy: re-evaluate whether treatment is still necessary. If continued, use the lowest effective dose and observe the neonate if the mother was under treatment in the 3rd trimester.
• Breast-feeding: if absolutely necessary, do not exceed 10 mg daily.