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Haldol (haloperidol)

All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.

Brand and Generic Names

Brand name: Haldol®
- Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg
- Liquid: Oral concentrate as haloperidol lactate 2 mg/mL
- Injection: Haloperidol lactate (short-acting) 5 mg/mL, haloperidol decanoate (long-acting) 50 mg/mL and 100 mg/mL
Generic name: Haloperidol

What is Haldol® and what does it treat?

Haloperidol is a first generation antipsychotic (FGA) medication approved for the treatment of schizophrenia. Haloperidol can improve symptoms of schizophrenia such as: hallucinations, delusions, and disorganized thinking; in some people, improvement in social isolation, reduced speech productivity and motivation also occur. It is also used for tics and vocal utterances of Tourette’s disorder and the management of severe behavioral problems in children. The remainder of this medication sheet will focus primarily on schizophrenia.

What is the most important information I should know about Haldol®?

Relapse is very common in schizophrenia and the most frequent cause is that patients stop taking their medication. Even when medication is taken exactly as prescribed, relapse may still occur for some people. Therefore it is recommended that you take your medication exactly as prescribed by your healthcare provider as this has been shown to decrease relapse.

Schizophrenia requires long-term treatment. Only your healthcare provider can determine the length of haloperidol treatment that is right for you.
Do not stop taking haloperidol or change your dose, without talking to your healthcare provider first.
Some people may develop side effects while taking haloperidol such as extrapyramidal effects (restlessness, tremor, stiffness) or tardive dyskinesia (slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements). If you develop movements that you cannot control, call your healthcare provider immediately.
Haloperidol treatment may be associated with strokes and/or transient ischemic attacks (TIAs) in elderly people with dementia and accompanying behavior problems. This safety concern has not been proven confidently, but there is some evidence. Talk with your health care provider if you are concerned or have questions.
Haloperidol treatment may be associated with strokes and/or transient ischemic attacks (TIAs) in elderly people with dementia and accompanying behavior problems. This safety concern has not been proven confidently, but there is some evidence. Talk with your healthcare provider if you are concerned or have questions.
Both older first and newer second generation antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular conduction of an electrical impulse in the heart). To minimize this possibility, antipsychotic medications should be used in the smallest effective dose in situations where the benefits outweigh the risks, such as schizophrenia or bipolar disorder. Often an EKG tracing may be ordered to monitor for conduction changes.
Haloperidol treatment must be monitored by a healthcare provider. Be sure to keep all of your scheduled appointments so that you stay healthy while on haloperidol.
You should not take illegal drugs or drink alcohol while taking haloperidol.

Are there specific concerns about Haldol®and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions, each with risks and benefits related to how the illness, medications and the risks to the fetus may interact. This is a complex decision as untreated schizophrenia has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.

Regarding breast-feeding, caution is advised since haloperidol does pass into breast milk.

What should I discuss with my healthcare provider before taking Haldol®?

Symptoms of schizophrenia which are bothersome to you.
If you had any serious side effects with other antipsychotic medications like muscle stiffness, muscle cramping, shaking, tardive dyskinesia, neuroleptic malignant syndrome, weight gain, or diabetes. (See the NAMI Hearts and Minds Program.)
If you have had an allergic reaction to haloperidol or any other medication.
History of heart problems, such as heart rhythm problems, long QT syndrome, or heart attacks. These illnesses may make haloperidol unsafe for you to take
Medical problems you have, especially diabetes, high cholesterol or triglycerides, increased body weight, seizures, or kidney disease or impairment.

How should I take Haldol®?

Haloperidol can be taken with or without food but should be taken with a full glass of water.
Only your doctor can determine the correct dose for you. Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
Use a calendar or pill box to help you remember to take your medication. Or, have a family member or friend remind you or check in with you to be sure you are taking your medication.

What happens if I miss a dose of Haldol®?

If you miss a dose of haloperidol take it as soon as you remember it, if it is not too close to when your next dose is due—discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.

What should I avoid while taking Haldol®?

Haloperidol may cause dizziness or drowsiness, especially when first starting the medication. Make sure you know how you react to the medication before you drive, operate machinery, or do other activities that may be dangerous if you are not alert.
Avoid drinking alcohol or using illegal drugs while taking haloperidol.

What happens if I overdose with Haldol®?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center at 1-800-222-1222.

What are the possible side effects of Haldol®?

What are the common side effects seen with haloperidol?

Common side effects of haloperidol usually include sleepiness, dizziness, rapid heartbeat, constipation, excess saliva production and weight gain. Another important side effect that occurs commonly is orthostatic hypotension (a lowering of your blood pressure when you are sitting up or standing up). Occasionally this can lead to fainting and falling down, therefore, people taking haloperidol should be careful when they change positions. These side effects are usually mild and go away after the first several days of starting treatment or increasing a dose.
Patients receiving haloperidol decanoate long-acting injection may notice some pain at the site of the injection.
Haloperidol has the potential of causing extrapyramidal symptoms (EPS) such as muscle spasms, cramps, or posturing movements common to other antipsychotic medications, and side effects such as restlessness, muscle rigidity, and tremor.

What are the more serious side effects of antipsychotics?

Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, neurological disorder most often caused by an adverse reaction to antipsychotic medications. Symptoms of (NM) include sudden high fever, sweating, changing blood pressure, dizziness, fatigue, muscle stiffness, as well as changes in liver and kidney function. In most cases, the disorder develops within the first 2 weeks of medication treatment. Early identification of and treatment for individuals with neuroleptic malignant syndrome slows the progression and improves recovery from (NMS). A different antipsychotic can be started very slowly once recovery is complete, although there is a risk that the syndrome might recur. Notify your healthcare provider immediately if you suspect you are developing “NMS”.
Less commonly seen, but important, is the early death/dementia risk as noted in the FDA boxed warning. In some clinical trials, it was determined that elderly people developed strokes at a higher rate than those on placebo medication (sugar pill). The SGA group has less tardive dyskinesia (TD), neuroleptic malignant syndrome, seizures, and changes in heart rhythm than FGA drugs but not zero.

What do I do about the more serious risks?

Please let your doctors know if you have any of these medical conditions prior to starting haloperidol: history of heart problems, such as heart rhythm problems, long QT syndrome, or heart attacks; diabetes; high cholesterol or triglycerides; increased body weight; seizures; or kidney disease or impairment.

Also, obtain Abnormal Involuntary Movement testing (AIMS) to monitor for tardive dyskinesia (TD). Regular AIMS testing is needed for monitoring, so you can make good choices about the use of the drug when weighing the risks and benefits.

Are there any risks for taking Haldol® for long periods of time?

Tardive dyskinesia (TD) is a side effect that may develop with prolonged use of antipsychotics. Should you develop symptoms of TD, such as grimacing, sucking and smacking of lips, and other movements that you cannot control, contact your healthcare provider immediately.

What other drugs may interact with Haldol® ?

Any other medication that causes sleepiness or low blood pressure may increase the same side effects of haloperidol and increase your chances of falling. Talk to your healthcare provider or pharmacist before starting any other medication, including over-the-counter medications, vitamins, dietary supplements, and natural (herbal) products.
Medications that may increase levels of haloperidol in your body: ciprofloxacin (Cipro®), cimetidine (Tagamet®), erythromycin, fluoxetine (Prozac®), fluvoxamine (Luvox®), isoniazid, mexiletine (Mexitil®), paroxetine (Paxil®), and azole antifungals (Ketoconazloe, Nizoral®).
Medications that may decrease levels of haloperidol in your body: carbamazepine (Tegretol®), lopinavir/ritonavir (Kaletra®), ritonavir (Norvir®), phenobarbital, phenytoin (Dilantin®), rifampin (Rifadin®), oxcarbazepine (Trileptal®). Cigarette smoking may also decrease the effectiveness of haloperidol.

How long does it take for Haldol® to work?

Haloperidol rebalances dopamine to improve thinking, mood, and behavior. Improvement of some symptoms may be noticed in some patients within a few weeks. The full benefit of haloperidol may not be seen for 6-12 weeks or longer.

FDA ALERT [06/06/2008]

Both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis.

Antipsychotics are not indicated for the treatment of dementia-related psychosis.

Updated by
Raymond A. Lorenz, PharmD, BCPP
(June 2010)

NAMI wishes to thank the College of Psychiatric and Neurologic Pharmacists for producing this fact sheet.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director

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