Research: Haloperidol (Haldol) Poses Risks in Dementia

Are antipsychotic medications safe and effective for use in people living with dementia? Let's look at one antipsychotic medication—Haldol (haloperidol)—and what research concludes about its use in Alzheimer's and other types of dementia.

Haldol is one kind of an antipsychotic medication called a typical antipsychotic (also referred to as a first generation antipsychotic), which places it in a classification of an older medication that often has more risks. Several of the other antipsychotic medications currently prescribed are classified as atypical, which is a newer kind of antipsychotic medication that usually has fewer side effects than the typical ones.

Antipsychotics are sometimes prescribed to help control some of the challenging behaviors that people with dementia experience. The initial approach to behaviors should always be to use behavior modification strategies and attempt to determine the causes behind the behaviors since we know that most behavior has meaning. However, medications are also prescribed when these non-drug approaches are ineffective.

One study published in the online journal BMJ outlines research on antipsychotic medications and their use in people with Alzheimer's and other dementias.

This particular study reviewed more than 75,000 people in the United States who had been prescribed antipsychotic medications in nursing homes from 2001-2005. (Data from people in nursing homes is often easier to collect than for people residing at home; nursing homes are required to report data regularly since they receive funding from Medicare and Medicaid.) Researchers tracked the doses and the type of antipsychotic medication, as well as the mortality rates of those receiving the medications.

The results show that those receiving Haldol (haloperidol) in a nursing home had a significantly increased risk of death, especially shortly after treatment is started, compared to other types of antipsychotic medications.

A second study that was conducted in community-dwelling persons with dementia (those who were living in a home instead of a facility) agrees with this conclusion, finding a higher risk of death in those who were receiving Haldol as compared to those who received Risperdal (risperidone), a typical, or second generation, antipyschotic.

A third study looked at Haldol and its use in persons who were inpatient at a psychiatric hospital and had a diagnosis of dementia. Contrary to the first two studies, researchers here found that there was no increased risk of sudden cardiac death with Haldol use.​

A fourth study reviewed several previously research studies that had been conducted on the use of medications to treat agitation in dementia. This study concluded that Haldol had not demonstrated effectiveness in reducing agitation in dementia and thus, it was not recommended for use.

If your loved one is in a nursing home, be aware that good facilities monitor the use of antipsychotics very closely. These medications have to be periodically reduced, and they should not be used without trying non-drug interventions first. Antipsychotic medications may only be prescribed to treat specific target behaviors that are dangerous for the person or others around them, not just for more benign behaviors such as restlessness or wandering.

Also, the risks and benefits of using antipsychotic medications need to be identified and discussed. There are situations where the benefits (for example, reducing distressing hallucinations and paranoia) may outweigh the risks of antipsychotics.

When multiple research studies identify a potential risk, such as with the use of Haldol in dementia, it highlights your role as an advocate for a family member or friend with dementia. If your loved one is on an antipsychotic, particularly Haldol, you might consider asking questions about why that drug was chosen, if another medication could be used instead, or if the medication can be decreased or stopped.

While there may be times that a physician prescribes Haldol for someone with dementia based on their specific condition and diagnoses, an awareness of the related concerns is important. Overall, research has found that the use of antipsychotics to treat agitation in dementia is questionable, both in safety and effectiveness.