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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Haldol Decanoate
Generic Name
Haloperidol Decanoate
Active Ingredient
HaloperidolCategory
Typical Antipsychotic [EPC]
Variants
2
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Haldol Decanoate, you must consult a qualified healthcare professional.
Detailed information about Haldol Decanoate
Haloperidol is a potent first-generation (typical) antipsychotic used to treat schizophrenia, Tourette’s syndrome, and severe behavioral problems. It works primarily by blocking dopamine D2 receptors in the brain.
Dosage for haloperidol must be highly individualized based on the patient's response and the severity of the condition being treated. Healthcare providers typically start with a low dose and titrate upward to find the minimum effective dose.
Haloperidol is approved for use in children aged 3 to 12 years for specific indications. It is generally not recommended for children under 3 years of age.
In pediatric patients, the dose should be increased gradually. If a child does not show improvement within 2 to 4 weeks, the medication should generally be discontinued or re-evaluated by a specialist.
While the kidneys excrete about 40% of the drug, dose adjustments are not strictly defined by creatinine clearance. However, because renal failure can alter fluid balance and electrolyte levels (which affects heart rhythm), clinicians should use caution and monitor renal function periodically.
Since haloperidol is extensively metabolized by the liver, patients with hepatic impairment (such as cirrhosis) may experience higher drug levels and increased toxicity. Healthcare providers typically reduce the starting dose by 50% and monitor liver enzymes closely.
Older adults are significantly more sensitive to the effects of haloperidol. The standard recommendation is to start at 25% to 50% of the usual adult dose (e.g., 0.5 mg once or twice daily). Elderly patients are at a much higher risk for falls, confusion, and extrapyramidal symptoms.
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and return to your regular schedule. Do not double the dose to catch up, as this increases the risk of acute dystonia (painful muscle spasms).
An overdose of haloperidol is a medical emergency. Symptoms include severe extrapyramidal reactions (uncontrollable movements), extreme sedation, dangerously low blood pressure (hypotension), and cardiac arrhythmias (irregular heartbeat). In severe cases, it can lead to coma or respiratory depression. If an overdose is suspected, call 911 or your local emergency services immediately. Treatment usually involves gastric lavage, supportive care, and the administration of anticholinergic medications to reverse muscle spasms.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop the medication without medical guidance, as sudden discontinuation can cause withdrawal symptoms.
Because haloperidol is a potent dopamine blocker, side effects related to the motor system are very common. These are often referred to as Extrapyramidal Symptoms (EPS).
Haloperidol is a high-potency medication that affects the central nervous system. Patients should be aware that it may take several weeks to see the full therapeutic effect. It is critical never to stop the medication abruptly, as this can lead to a return of psychotic symptoms or a withdrawal syndrome characterized by nausea, vomiting, and dizziness.
Dementia-Related Psychosis: According to the FDA, elderly patients with dementia-related psychosis who are treated with antipsychotic medications, including haloperidol, face a significantly higher risk of death compared to those taking a placebo. Clinical trials showed that the risk of death was 1.6 to 1.7 times higher in the drug-treated group. Haloperidol is not indicated for the management of behavioral disturbances in elderly patients with dementia. Healthcare providers should consider alternative treatments for this population.
Certain medications should never be combined with haloperidol due to the risk of life-threatening complications.
There are specific medical scenarios where the risks of haloperidol far outweigh any potential benefits. In these cases, the drug must NEVER be used.
Haloperidol is classified as FDA Pregnancy Category C (under the older system). There are no adequate and well-controlled studies in pregnant humans. However, data from animal studies have shown potential for limb malformations at high doses.
Trimester-Specific Risks:
Haloperidol should only be used during pregnancy if the potential benefit to the mother justifies the potential risk to the fetus. Untreated schizophrenia also carries significant risks for both mother and child.
Haloperidol is a high-potency antagonist of central dopamine receptors, specifically the D2 subtype. It binds with high affinity to D2 receptors in the mesolimbic and mesocortical tracts of the brain. By blocking these receptors, it reduces the dopaminergic overactivity associated with the 'positive' symptoms of schizophrenia (hallucinations, delusions, and disorganized thought).
In the nigrostriatal pathway, this same D2 blockade leads to the unwanted motor effects (EPS). In the tuberoinfundibular pathway, it prevents dopamine from inhibiting prolactin release, leading to elevated prolactin levels. Haloperidol also possesses minor antagonist activity at the Alpha-1 adrenergic receptor (leading to hypotension) and very weak activity at Histamine H1 and Muscarinic M1 receptors (leading to minimal sedation and anticholinergic effects compared to other antipsychotics).
Common questions about Haldol Decanoate
Haloperidol is primarily used to treat schizophrenia and other psychotic disorders by reducing symptoms like hallucinations and delusions. It is also FDA-approved to control the motor and vocal tics associated with Tourette’s syndrome in both children and adults. Additionally, healthcare providers may prescribe it for severe behavioral problems in children who exhibit explosive hyperexcitability. In some hospital settings, it is used off-label to manage acute delirium or intractable hiccups. It is a potent medication that works by balancing dopamine levels in the brain.
The most common side effects of haloperidol are related to movement, often called extrapyramidal symptoms (EPS). These include restlessness (akathisia), muscle stiffness, tremors, and slowed physical movements. Many patients also experience significant drowsiness, dry mouth, and blurred vision during the first few weeks of treatment. Some individuals may notice weight gain or changes in sexual function due to increased prolactin levels. It is important to report any stiff muscles or unusual movements to your doctor immediately, as these can often be managed with dose adjustments.
No, you should strictly avoid alcohol while taking haloperidol. Alcohol can dangerously increase the sedative effects of the medication, leading to extreme drowsiness and impaired coordination. Combining the two also increases the risk of severe low blood pressure and respiratory depression, which can be life-threatening. Alcohol can also worsen the underlying psychiatric symptoms that haloperidol is intended to treat. Always consult your healthcare provider before consuming any substance that affects the central nervous system.
Haloperidol should only be used during pregnancy if the potential benefits outweigh the risks to the developing fetus. It is classified as Category C, meaning animal studies have shown some risks, but human data is limited. Babies born to mothers who took haloperidol in the third trimester may experience withdrawal symptoms or movement disorders after birth. These symptoms can include tremors, muscle stiffness, or breathing difficulties. If you are pregnant or planning to become pregnant, discuss a comprehensive treatment plan with your psychiatrist and obstetrician.
The timeline for haloperidol's effectiveness depends on the condition being treated and the form of the medication. For acute agitation, an intramuscular injection can begin working within 30 to 60 minutes. For chronic conditions like schizophrenia, you may notice a calming effect within the first few days, but the full antipsychotic benefits usually take 4 to 6 weeks to manifest. It is important to continue taking the medication as prescribed, even if you do not feel better right away. Do not stop the medication without consulting your doctor, as the full benefits take time to stabilize.
You should never stop taking haloperidol suddenly unless specifically instructed by your doctor. Abruptly discontinuing the medication can cause a 'withdrawal' or 'discontinuation' syndrome, which includes symptoms like nausea, vomiting, insomnia, and tremors. More importantly, stopping the drug suddenly significantly increases the risk of a relapse of psychotic symptoms or tics. If you need to stop the medication, your healthcare provider will create a tapering schedule to slowly lower your dose. This process ensures your brain chemistry adjusts safely to the change.
If you miss a dose of haloperidol, take it as soon as you remember. However, if it is almost time for your next scheduled dose, you should skip the missed dose and simply take the next one at the regular time. Never take two doses at once to make up for a missed one, as this increases the risk of acute muscle spasms and severe sedation. Maintaining a consistent level of the medication in your bloodstream is key to its effectiveness. If you frequently forget doses, consider using a pill organizer or setting a daily alarm.
Haloperidol can cause weight gain, although it is generally less likely to do so than newer 'atypical' antipsychotics like olanzapine or clozapine. The weight gain is often due to increased appetite or metabolic changes caused by the medication. Some patients may also experience increased thirst, leading them to consume high-calorie beverages. Monitoring your weight and maintaining a balanced diet and regular exercise routine can help manage this side effect. If you notice significant or rapid weight gain, discuss it with your healthcare provider to evaluate your metabolic health.
Haloperidol has many potential drug interactions, some of which can be very serious. It should not be taken with drugs that also affect the heart's rhythm (QT interval) or with medications for Parkinson's disease. Combining it with other CNS depressants like opioids or benzodiazepines can cause excessive sedation. Some antibiotics and antifungal medications can increase the levels of haloperidol in your blood to toxic levels. Always provide your doctor and pharmacist with a complete list of all medications, including over-the-counter supplements and herbs like St. John's Wort.
Yes, haloperidol is widely available as a generic medication in several forms, including oral tablets and injectable solutions. The generic versions are bioequivalent to the original brand-name Haldol, meaning they contain the same active ingredient and work the same way in the body. Generic haloperidol is typically much more affordable than brand-name antipsychotics. Most insurance plans cover generic haloperidol as a 'Tier 1' or low-cost medication. Check with your pharmacist to ensure you are receiving the correct formulation prescribed by your doctor.
Other drugs with the same active ingredient (Haloperidol)
> Warning: Stop taking Haloperidol and call your doctor immediately if you experience any of these serious conditions.
Prolonged use of haloperidol (months to years) requires careful monitoring for Tardive Dyskinesia. The risk increases with the duration of treatment and the total cumulative dose. Additionally, long-term dopamine blockade can lead to 'negative' symptoms such as emotional blunting, lack of motivation, and cognitive slowing. Regular assessment using the AIMS (Abnormal Involuntary Movement Scale) is recommended every 6 months for patients on long-term therapy.
Increased Mortality in Elderly Patients with Dementia-Related Psychosis: The FDA has issued a black box warning stating that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Most deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Haloperidol is NOT approved for the treatment of patients with dementia-related psychosis.
Report any unusual symptoms to your healthcare provider. Early detection of side effects often allows for dose adjustments that can improve quality of life while maintaining the drug's benefits.
To ensure safety, your healthcare provider may require the following tests:
Haloperidol may impair your mental and physical abilities. It frequently causes drowsiness and slowed reaction times. You should not drive, operate heavy machinery, or engage in hazardous activities until you know how the medication affects you. This is especially important during the first two weeks of treatment or after a dose increase.
Alcohol must be avoided while taking haloperidol. Alcohol significantly increases the sedative effects of the drug and can lead to dangerous respiratory depression (slowed breathing) and severe low blood pressure. Combining the two also increases the risk of falls and accidents.
Stopping haloperidol suddenly can cause 'discontinuation syndrome.' Symptoms include sweating, tremors, rapid heart rate, insomnia, and the return of hallucinations. If the medication needs to be stopped, your doctor will provide a tapering schedule to slowly reduce the dose over several weeks.
> Important: Discuss all your medical conditions, especially heart, liver, or neurological issues, with your healthcare provider before starting Haloperidol.
Haloperidol can interfere with certain medical tests:
For each major interaction, the management strategy usually involves either avoiding the combination, adjusting the dose of haloperidol, or increasing the frequency of ECG and blood work monitoring.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. Even over-the-counter cold medicines can interact with Haloperidol.
These are conditions where haloperidol should only be used if no other options exist, and only under intense medical supervision.
Patients who have had a severe reaction to Droperidol (another butyrophenone used for nausea) are highly likely to have a cross-sensitivity to haloperidol. While there is no direct cross-sensitivity with 'atypical' antipsychotics (like quetiapine) or phenothiazines (like prochlorperazine), patients with a history of Neuroleptic Malignant Syndrome (NMS) from ANY antipsychotic are at a significantly higher risk of developing it again with haloperidol.
> Important: Your healthcare provider will evaluate your complete medical history, including any history of heart rhythm problems or movement disorders, before prescribing Haloperidol.
Haloperidol is excreted into human breast milk. Studies have found that the amount of drug the infant receives is relatively low (about 2-3% of the mother's weight-adjusted dose). However, because haloperidol is a potent dopamine blocker, there is a risk it could affect the developing nervous system or prolactin levels of the infant. If a mother must take haloperidol while breastfeeding, the infant should be closely monitored for excessive sedation, poor feeding, and developmental milestones.
Haloperidol is FDA-approved for children as young as 3 years old for Tourette's and severe behavioral disorders. However, it is not a first-line treatment. Children are more susceptible to acute dystonic reactions (painful muscle spasms). Long-term use in children requires careful monitoring of growth and development, as the drug's effect on the pituitary gland (via prolactin) can theoretically impact puberty and bone density.
As noted in the Black Box Warning, haloperidol carries a high risk for elderly patients with dementia. Even in elderly patients without dementia, the drug is listed on the Beers Criteria as a potentially inappropriate medication. Older adults have reduced hepatic clearance and are more likely to have underlying heart disease. They are at an extreme risk for falls due to sedation and orthostatic hypotension. The motto for haloperidol in the elderly is 'start low and go slow.'
While haloperidol is not primarily cleared by the kidneys, renal impairment can lead to electrolyte imbalances (like low potassium). Since haloperidol can affect the heart rhythm, these imbalances increase the risk of Torsades de Pointes. No specific dose adjustment is required for GFR, but caution is advised.
Because the liver is the primary site of haloperidol metabolism, patients with hepatic impairment (Child-Pugh Class B or C) will have significantly higher drug levels. This increases the risk of NMS and EPS. A dose reduction of 50% is generally recommended for patients with significant liver disease.
> Important: Special populations require individualized medical assessment. Always inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding.
| Parameter | Value |
|---|---|
| Bioavailability | 60% - 70% (Oral) |
| Protein Binding | 92% (Primarily Albumin) |
| Half-life | 12 - 38 Hours (Oral) |
| Tmax | 2 - 6 Hours (Oral) |
| Metabolism | Hepatic (CYP3A4, CYP2D6) |
| Excretion | Renal 40%, Fecal 15% |
Haloperidol is the prototypical Typical Antipsychotic (First-Generation Antipsychotic). It is specifically a member of the Butyrophenone class. Related medications include droperidol (used for anesthesia/nausea) and pimozide (used for Tourette's). It differs from phenothiazine antipsychotics (like chlorpromazine) by being much more potent and having fewer sedative and anticholinergic side effects, but a higher risk of movement disorders.