First-generation (typical) antipsychotic; high-potency butyrophenone derivative
Potent dopamine D₂ receptor antagonist; minimal anticholinergic or antihistaminergic activity contributes to its high risk of extrapyramidal symptoms (EPS) and low sedative burden.
Schizophrenia, Tourette’s disorder, severe behavioral disturbances
Acute agitation, delirium, psychosis in dementia, aggression in neurodevelopmental disabilities (higher adverse risk), and chemotherapy-induced nausea and vomiting
Oral tablets, oral solution, short-acting intramuscular (IM), intravenous (IV, off-label), and long-acting IM decanoate injection
Oral dosing often begins at 1–2 mg p.o. twice daily, titrated as needed based on clinical response and tolerability. In acute settings, IM dosing ranges from 2.5–10 mg per injection, repeated as needed. The long-acting decanoate injection is typically given every 4 weeks, with oral overlap required for the first 1–2 weeks.
Oral: 1–20 mg/day in divided doses; Decanoate IM: 50–200 mg every 4 weeks
Metabolized primarily by CYP3A4 and CYP2D6. The decanoate form has a prolonged half-life (up to 3 weeks), reaching steady state after multiple injections.
Extrapyramidal symptoms (including parkinsonism, dystonia, and akathisia), sedation, restlessness, and orthostatic hypotension
Tardive dyskinesia, neuroleptic malignant syndrome (NMS), QTc prolongation, sudden cardiac death, and hyperprolactinemia
Baseline and periodic evaluation for EPS (e.g., AIMS scale every 6–12 months), ECG if cardiac risk factors or IV use, and annual metabolic screening. Consider prolactin or LFTs if symptomatic.
Increased mortality in elderly patients with dementia-related psychosis
Haloperidol is frequently used to manage acute agitation or psychosis in dementia, intellectual disability, and traumatic brain injury (TBI), but must be used cautiously due to high EPS risk, fall risk, and its black box warning for increased mortality in elderly individuals with dementia-related psychosis. Long-acting formulations may support adherence in chronic psychotic illness but require close monitoring for motor side effects.