Editing Haloperidol (section)

== Medical uses ==
Haloperidol is used in the control of the symptoms of:

* Acute [[psychosis]], such as drug-induced psychosis caused by [[ketamine]],<ref>{{cite journal | vauthors = Giannini AJ, Underwood NA, Condon M | title = Acute ketamine intoxication treated by haloperidol: a preliminary study | journal = American Journal of Therapeutics | volume = 7 | issue = 6 | pages = 389–391 | date = November 2000 | pmid = 11304647 | doi = 10.1097/00045391-200007060-00008 }}</ref>{{Unreliable medical source|reason=Primary study|date=November 2024}} and [[phencyclidine]],<ref>{{cite journal | vauthors = Giannini AJ, Eighan MS, Loiselle RH, Giannini MC | title = Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis | journal = Journal of Clinical Pharmacology | volume = 24 | issue = 4 | pages = 202–204 | date = April 1984 | pmid = 6725621 | doi = 10.1002/j.1552-4604.1984.tb01831.x | s2cid = 42278510 }}</ref> and psychosis associated with high fever or metabolic disease. Some evidence has found haloperidol to worsen psychosis due to psilocybin.<ref>{{cite journal | vauthors = Johnson M, Richards W, Griffiths R | title = Human hallucinogen research: guidelines for safety | journal = Journal of Psychopharmacology | volume = 22 | issue = 6 | pages = 603–620 | date = August 2008 | pmid = 18593734 | pmc = 3056407 | doi = 10.1177/0269881108093587 | publisher = [[SAGE Publications]] }}</ref>
* Adjunctive treatment of alcohol and opioid withdrawal
* Agitation and confusion associated with cerebral [[Sclerosis (medicine)|sclerosis]]
* [[alcohol (drug)|Alcohol]]-induced psychosis
* Hallucinations in [[alcohol withdrawal]]<ref name=NEJM2014 />
* Hyperactive [[delirium]] (to control the agitation component of delirium)
* [[Hyperactivity]], [[aggression]]
* Otherwise uncontrollable, severe behavioral disorders in children and adolescents
* [[Schizophrenia]]<ref name="FDA" />
* Therapeutic trial in [[personality disorders]], such as [[borderline personality disorder]]
* Treatment of intractable [[hiccups]]<ref name="BNF">{{cite book |isbn = 978-0-85711-084-8 |title = British National Formulary (BNF) | author = Joint Formulary Committee |year = 2013 |publisher = Pharmaceutical Press |location = London, England |edition = 65th |pages = [https://archive.org/details/bnf65britishnati0000unse/page/229 229–30] |url = https://archive.org/details/bnf65britishnati0000unse/page/229 }}</ref><ref name = MD />
* Treatment of neurological disorders, including [[tic disorder]]s such as [[Tourette syndrome]], and [[Chorea (disease)|chorea]]
* Treatment of severe nausea and emesis in postoperative and [[palliative care]], especially for palliating adverse effects of [[radiation therapy]] and [[chemotherapy]] in [[oncology]]. Also used as a first line antiemetic for acute [[cannabinoid hyperemesis syndrome]].
* As chemical restraint in acute care psychiatry, mainly for violent and self-harming patients (controversial use but very commonly found in movies).<ref name="pmid15985915" />

Haloperidol was considered indispensable for treating psychiatric emergency situations.<ref name="pmid15985915">{{cite journal | vauthors = Currier GW | title = The controversy over "chemical restraint" in acute care psychiatry | journal = Journal of Psychiatric Practice | volume = 9 | issue = 1 | pages = 59–70 | date = January 2003 | pmid = 15985915 | doi = 10.1097/00131746-200301000-00006 | publisher = [[Lippincott Williams & Wilkins]] | s2cid = 22342074 }}</ref><ref name="pmid3736271">{{cite journal |vauthors=Cavanaugh SV |date=September 1986 |title=Psychiatric emergencies |journal=The Medical Clinics of North America |volume=70 |issue=5 |pages=1185–1202 |doi=10.1016/S0025-7125(16)30919-1 |pmid=3736271}}</ref> However, the newer atypical drugs have gained a greater role in a number of situations, as outlined in a series of consensus reviews published between 2001 and 2005.<ref name="pmid11500996">{{cite journal | vauthors = Allen MH, Currier GW, Hughes DH, Reyes-Harde M, Docherty JP | title = The Expert Consensus Guideline Series. Treatment of behavioral emergencies | journal = Postgraduate Medicine | issue = Spec No | pages = 1–88; quiz 89–90 | date = May 2001 | pmid = 11500996 }}</ref><ref name="pmid15985913">{{cite journal | vauthors = Allen MH, Currier GW, Hughes DH, Docherty JP, Carpenter D, Ross R | title = Treatment of behavioral emergencies: a summary of the expert consensus guidelines | journal = Journal of Psychiatric Practice | volume = 9 | issue = 1 | pages = 16–38 | date = January 2003 | pmid = 15985913 | doi = 10.1097/00131746-200301000-00004 | s2cid = 29363701 }}</ref><ref name="pmid16319571">{{cite journal | vauthors = Allen MH, Currier GW, Carpenter D, Ross RW, Docherty JP | title = The expert consensus guideline series. Treatment of behavioral emergencies 2005 | journal = Journal of Psychiatric Practice | volume = 11 | issue = Suppl 1 | pages = 5–25 | date = November 2005 | pmid = 16319571 | doi = 10.1097/00131746-200511001-00002 | s2cid = 72366588 }}</ref>

In a 2013 comparison of 15 antipsychotics in schizophrenia, haloperidol demonstrated standard effectiveness. It was 13–16% more effective than [[ziprasidone]], [[chlorpromazine]], and [[asenapine]], approximately as effective as [[quetiapine]] and [[aripiprazole]], and 10% less effective than [[paliperidone]].<ref name=pmid23810019>{{cite journal | vauthors = Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM | title = Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis | journal = Lancet | volume = 382 | issue = 9896 | pages = 951–962 | date = September 2013 | pmid = 23810019 | doi = 10.1016/S0140-6736(13)60733-3 | s2cid = 32085212 }}</ref> A 2013 [[systematic review]] compared haloperidol to [[placebo]] in schizophrenia:<ref name=Ada2013>{{cite journal | vauthors = Adams CE, Bergman H, Irving CB, Lawrie S | title = Haloperidol versus placebo for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 11 | pages = CD003082 | date = November 2013 | pmid = 24242360 | doi = 10.1002/14651858.CD003082.pub3 | url = http://www.cochrane.org/CD003082/SCHIZ_haloperidol-versus-placebo-for-schizophrenia | url-status = live | doi-access = free | pmc = 11558230 | archive-url = https://web.archive.org/web/20170820120020/http://www.cochrane.org/CD003082/SCHIZ_haloperidol-versus-placebo-for-schizophrenia | archive-date = 20 August 2017 }}</ref>

{| class="wikitable"
! Summary
|-
|Haloperidol often causes troublesome adverse effects. If there is no other antipsychotic drug, using haloperidol to offset the consequences of untreated schizophrenia is justified. Where a choice of drug is available, however, an alternative [[antipsychotic]] with less likelihood of adverse effects such as parkinsonism, [[akathisia]] and acute [[dystonias]] may be more desirable.<ref name=Ada2013 />
|-
| style="padding:0;" |
{| class="wikitable collapsible collapsed" style="width:100%;"
|-
! scope="col" style="text-align: left;"| Outcome
! scope="col" style="text-align: left;"| Findings in words
! scope="col" style="text-align: left;"| Findings in numbers
! scope="col" style="text-align: left;"| Quality of evidence
|-
! colspan="4" style="text-align: left;"| General outcomes
|-
| No marked global improvement<br />Follow-up: >6–24 weeks || Haloperidol, when compared with placebo, reduces the chance of experiencing 'no improvement'. Data are based on moderate quality evidence.
 || [[Relative risk|RR]] 0.67 (0.58 to 0.78) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|Moderate]]
|-
| Not discharged from hospital<br />Follow-up: > 6–24 weeks || Haloperidol may reduce the chance of staying in hospital, but, at present it is not possible to be confident about the difference between people receiving haloperidol and people taking placebo. Data supporting this finding are very limited.
 || [[Relative risk|RR]] 0.85 (0.47 to 1.52) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|Very low]]
|-
| Relapse<br />Follow-up: < 52 weeks || Haloperidol may reduce the chance of relapse, but, at present there is only very limited data supporting this finding.
 || [[Relative risk|RR]] 0.69 (0.55 to 0.86) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|Very low]]
|-
! colspan="4" style="text-align: left;"| Leaving the study early
|-
| Follow-up: > 6–24 weeks || Haloperidol probably slightly reduces the risk of loss to follow up, but the difference between the two treatments is not quite clear. Data supporting this finding are based on moderate quality evidence.
 || [[Relative risk|RR]] 0.54 (0.29 to 1) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|Moderate]]
|-
! colspan="4" style="text-align: left;"| [[Adverse event|Adverse effects]] – movement disorders
|-
| Parkinsonism<br />Follow-up: 3 weeks to 3 months || Haloperidol substantially increases the risk of movement disorders. Data are based on moderate quality evidence.
 || [[Relative risk|RR]] 5.48 (2.68 to 11.22) || [[The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach|Moderate]]
|-
! colspan="4" style="text-align: left;"| Missing outcomes
|-
| || Severe adverse events, such as death, and outcomes such as [[Patient satisfaction|satisfaction with treatment]] were not measured/reported in the included studies. ||  ||
|-
|}
|}

In contrast to certain other antipsychotics like [[risperidone]], haloperidol is ineffective as a [[trip killer|hallucinogen antidote or "trip killer"]] in blocking the effects of [[serotonergic psychedelic]]s like [[psilocybin]] and [[lysergic acid diethylamide]] (LSD).<ref name="HalmanKongSarris2024">{{cite journal | vauthors = Halman A, Kong G, Sarris J, Perkins D | title = Drug-drug interactions involving classic psychedelics: A systematic review | journal = J Psychopharmacol | volume = 38 | issue = 1 | pages = 3–18 | date = January 2024 | pmid = 37982394 | pmc = 10851641 | doi = 10.1177/02698811231211219 | url = }}</ref><ref name="Halberstadt2015">{{cite journal | vauthors = Halberstadt AL | title = Recent advances in the neuropsychopharmacology of serotonergic hallucinogens | journal = Behav Brain Res | volume = 277 | issue = | pages = 99–120 | date = January 2015 | pmid = 25036425 | pmc = 4642895 | doi = 10.1016/j.bbr.2014.07.016 | url = }}</ref><ref name="VollenweiderVollenweider-ScherpenhuyzenBäbler1998">{{cite journal | vauthors = Vollenweider FX, Vollenweider-Scherpenhuyzen MF, Bäbler A, Vogel H, Hell D | title = Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action | journal = NeuroReport | volume = 9 | issue = 17 | pages = 3897–3902 | date = December 1998 | pmid = 9875725 | doi = 10.1097/00001756-199812010-00024 | url = }}</ref>

=== Pregnancy and lactation ===

Data from [[Animal testing|animal experiments]] indicate haloperidol is not [[teratogenic]], but is [[embryotoxic]] in high doses.  In humans, no controlled studies exist.  Reports in pregnant women revealed possible damage to the fetus, although most of the women were exposed to multiple drugs during pregnancy. In addition, reports indicate [[neonates]] exposed to antipsychotic drugs are at risk for [[Extrapyramidal symptoms|extrapyramidal]] and/or withdrawal symptoms following delivery, such as agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder. Following accepted general principles, haloperidol should be given during pregnancy only if the benefit to the mother clearly outweighs the potential fetal risk.<ref name="FDA">{{cite web |url = https://www.drugs.com/pro/haldol.html |title = Haldol Official FDA information, side effects and uses |publisher = Drugs.com |access-date = 3 October 2013 |url-status = live |archive-url = https://web.archive.org/web/20131005001049/http://www.drugs.com/pro/haldol.html |archive-date = 5 October 2013 }}</ref>

Haloperidol is excreted in breast milk. A few studies have examined the impact of haloperidol exposure on breastfed infants and in most cases, there were no adverse effects on infant growth and development.<ref>{{Cite web|url=http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+132|title=LACTMED: Haloperidol|date=31 October 2018|access-date=18 January 2019}}</ref>

=== Other considerations ===
[[File:Haloperidol decanoate highlighting ester group.svg|class=skin-invert-image|thumb|right|[[Skeletal formula]] of [[haloperidol decanoate]]. The decanoate group is highlighted in {{color|red|red}}.]]

During long-term treatment of chronic psychiatric disorders, the daily dose should be reduced to the lowest level needed for maintenance of remission.  Sometimes, it may be indicated to terminate haloperidol treatment gradually.{{citation needed|date=April 2022}} In addition, during long-term use, routine monitoring including measurement of BMI, blood pressure, fasting blood sugar, and lipids, is recommended due to the risk of side effects.<ref name="APA schizophrenia guideline" />

Other forms of therapy (psychotherapy, occupational therapy/ergotherapy, or social rehabilitation) should be instituted properly.{{Citation needed|date=April 2013}}
PET imaging studies have suggested low doses are preferable. Clinical response was associated with at least 65% occupancy of D2 receptors, while greater than 72% was likely to cause hyperprolactinaemia and over 78% associated with extrapyramidal side effects. Doses of haloperidol greater than 5&nbsp;mg increased the risk of side effects without improving efficacy.<ref>{{cite journal | vauthors = Oosthuizen P, Emsley RA, Turner J, Keyter N | title = Determining the optimal dose of haloperidol in first-episode psychosis | journal = Journal of Psychopharmacology | volume = 15 | issue = 4 | pages = 251–255 | date = December 2001 | pmid = 11769818 | doi = 10.1177/026988110101500403 | s2cid = 40788955 }}</ref> Patients responded with doses under even 2&nbsp;mg in first-episode psychosis.<ref>{{cite journal | vauthors = Tauscher J, Kapur S | title = Choosing the right dose of antipsychotics in schizophrenia: lessons from neuroimaging studies | journal = CNS Drugs | volume = 15 | issue = 9 | pages = 671–678 | year = 2001 | pmid = 11580306 | doi = 10.2165/00023210-200115090-00001 | s2cid = 30091494 }}</ref> For maintenance treatment of schizophrenia, an international consensus conference recommended a reduction dosage by about 20% every 6 months until a minimal maintenance dose is established.<ref name="APA schizophrenia guideline">{{cite web | author = Work Group on Schizophrenia |title = Practice Guideline for the Treatment of Patients With Schizophrenia | edition = Second  |url = http://psychiatryonline.org/content.aspx?bookID=28&sectionID=1665359#45892 |archive-url = https://web.archive.org/web/20120327230029/http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1665359#45892 |url-status = dead |archive-date = 27 March 2012 |access-date = 21 April 2014 }}</ref>
* Depot forms are also available; these are injected deeply intramuscularly at regular intervals. The depot forms are not suitable for initial treatment, but are suitable for patients who have demonstrated inconsistency with oral dosages.{{Citation needed|date=April 2013}}

The [[decanoate]] ester of haloperidol ([[haloperidol decanoate]], trade names Haldol decanoate, Halomonth, Neoperidole) has a much longer [[duration of action]], so is often used in people known to be noncompliant with oral medication. A dose is given by intramuscular injection once every two to four weeks.<ref>Goodman and Gilman's ''Pharmacological Basis of Therapeutics'', 10th edition (McGraw-Hill, 2001).{{page needed|date=September 2012}}</ref> The [[IUPAC name]] of haloperidol decanoate is [4-(4-chlorophenyl)-1-[4-(4-fluorophenyl)-4-oxobutyl]piperidin-4-yl] decanoate.

[[Topical medication|Topical formulations]] of haloperidol should not be used as treatment for nausea because research does not indicate this therapy is more effective than alternatives.<ref name="AAHPMfive">{{Cite journal |author1 = American Academy of Hospice and Palliative Medicine |author1-link = American Academy of Hospice and Palliative Medicine |title = Five Things Physicians and Patients Should Question |publisher = [[American Academy of Hospice and Palliative Medicine]] |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-hospice-palliative-medicine/ |access-date = 1 August 2013 |url-status = live |archive-url = https://web.archive.org/web/20130901101934/http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-hospice-palliative-medicine/ |archive-date = 1 September 2013 }}, which cites
* {{cite journal | vauthors = Smith TJ, Ritter JK, Poklis JL, Fletcher D, Coyne PJ, Dodson P, Parker G | title = ABH gel is not absorbed from the skin of normal volunteers | journal = Journal of Pain and Symptom Management | volume = 43 | issue = 5 | pages = 961–966 | date = May 2012 | pmid = 22560361 | doi = 10.1016/j.jpainsymman.2011.05.017 | doi-access = free }}
* {{cite journal | vauthors = Weschules DJ | title = Tolerability of the compound ABHR in hospice patients | journal = Journal of Palliative Medicine | volume = 8 | issue = 6 | pages = 1135–1143 | date = December 2005 | pmid = 16351526 | doi = 10.1089/jpm.2005.8.1135 }}</ref>