Haldol (Haloperidol Decanoate) - Intramuscular

What Is Haldol?

Haldol (haloperidol) is an injectable medication in the first-generation, or typical, antipsychotic drug class. You may be prescribed haloperidol if you have a type of schizophrenia that requires a longer course of injectable therapy. This medication is available by prescription and is administered via intramuscular (into the muscle) injection.

First-generation antipsychotics, and more specifically Haldol, work well for schizophrenia by blocking the effects of dopamine.

If you are an older adult with mental health issues related to dementia, Haldol has a warning for an increased risk of death relating to heart disease or infection.

Haldol is a long-acting injection, meaning it slowly releases the drug into the body over time. Other forms of haloperidol injection are available, including an oral version of haloperidol and haloperidol lactate, a short-acting intramuscular injection. Short-acting injections work quickly after administration but require more frequent injections.

What Is Haldol Used For?

The FDA approved Haldol to treat schizophrenia.

Haldol should not be used in older adults with dementia-related psychosis, as antipsychotics have been shown to increase the risk of death in this population.

How to Take Haldol

A healthcare provider will administer haloperidol as an injection into your muscle.

When regularly taking this medication, it is important to check your blood work, including a lymphocyte count. Haldol has a risk of decreasing your white and red blood cells, so it's important to ensure they are all within the normal range.

Storage

Since Haldol is given in a medical setting, you will likely not need to worry about storage.

However, Haldol should be stored at room temperature (68 F to 77 F), away from light. The medicine does not need to be refrigerated and should not be frozen.

Off-Label Uses

There are no off-label uses (uses other than what the FDA has specifically approved it for) for haloperidol decanoate. However, healthcare providers sometimes prescribe other forms of haloperidol, such as short-acting haloperidol lactate intramuscular injection and oral haloperidol for other health conditions.

Off-label uses for haloperidol lactate injection may include:

• Agitation and aggression
• Acute agitation associated with bipolar disorder
• Nausea and vomiting
• Delirium

What Are the Side Effects of Haldol?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects of Haldol are: 

• Extrapyramidal symptoms (involuntary or uncontrolled movements in your body)
• Tardive dyskinesia (repetitive and involuntary movements that may involve your tongue and face)
• Spasms of eyeball muscles (oculogyric crisis)
  

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:

• Heart-related effects, such as QTc interval-prolongation (abnormalities in the heart’s electrical system) and Torsades de Pointes (a type of fast heart rhythm)
• Jaundice (yellowing of the skin and whites of the eyes) or worsening liver function
• Decreased white blood cells (leukopenia)
  
• Neuroleptic malignant syndrome, usually seen as an inability to move your muscles and a high fever
• Allergic reactions, which can cause anaphylaxis, angioedema (swelling), skin reactions, and difficulty breathing

Long-Term Side Effects

One of Haldol's potential long-term side effects is the risk of withdrawal symptoms. If you take Haldol for a long period and stop it suddenly, you may experience tardive dyskinesia, even after discontinuation.

Dosage: How Much Haldol Should I Take?

A healthcare provider will administer Hadol via intramuscular injection. They will determine the appropriate dosage for you.

Modifications

Haldol does not typically require special dosing in adults; it is dosed the same even if you have problems with your kidney or liver.

If your child needs this medication, the dose will be adjusted based on height and weight.

Missed Dose

It is important to receive your Haldol injections as scheduled. If you miss a dose, contact your healthcare provider for guidance on what to do.

Overdose: What Happens If I Take Too Much Haldol?

If you receive too much Haldol, you may be more likely to experience the drug's side effects. Most likely, an overdose of Haldol will cause:

• Severe extrapyramidal symptoms
• Sedation
• Low blood pressure

There is no specific antidote. To treat an overdose, you must receive medical advice to treat the symptoms you are experiencing.

Precautions

What Are Reasons I Shouldn’t Take Haldol?

You should not receive Haldol if you:

• Have experienced severe toxic central nervous system depression
• Are in a coma
• Have Parkinson’s disease
• Have had an allergic reaction to haloperidol

What Other Medications Interact With Haldol?

Haldol can interact with other medications. Before starting treatment, tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Taking lithium, another medication used for behavioral disorders, with Haldol can cause weakness, fatigue, confusion, and other symptoms. You should also avoid taking Haldol with opioids and alcohol, as it can increase the sedative effects.

Other medications that can interact with Haldol include:

• Ketoconazole
• Sporanox (itraconazole)
• Nefazodone
• Buspirone
• Effexor XR (venlafaxine)
• Xanax (alprazolam)
• Luvox (fluvoxamine)
• Quinidine
• Prozac (fluoxetine)
• Zoloft (sertraline)
• Chlorpromazine
• Promethazine
• Tricyclic antidepressants, such as desipramine or imipramine
• Tegretol (carbamazepine)
• Rifampin

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Haldol.

What Medications Are Similar?

Other antipsychotic medications that can be used for schizophrenia include:

• Zyprexa (olanzapine)
• Risperdal (risperidone)
• Abilify (aripiprazole)
• Trilafon (perphenazine)
• Prolixin (fluphenazine)
• Thorazine (chlorpromazine)
• Seroquel (quetiapine)
• Geodon (ziprasidone)
• Clozaril (clozapine)

How Can I Stay Healthy While Taking Haldol?

To stay healthy while taking Haldol, it is important to follow the medical advice of your healthcare team. Avoid other substances or medications that may interact negatively with Haldol. Your healthcare provider can provide more detailed information on potential interactions.

Watch for the development of side effects related to your treatment. This can include muscle-related effects, such as restlessness, stiffness, tremors, or uncontrolled movements. Potentially serious side effects can cause a high fever, muscle stiffness, and heart-related side effects, such as a fast heart rate. Contact your healthcare provider immediately if you experience any of these symptoms.

Along with taking this medication as prescribed, it's important you get plenty of rest, stay hydrated, and eat a healthy diet as instructed by your healthcare provider.

The author would like to recognize and thank Chong Yol Gacasan Kim for contributing to this article.