ANNE ARUNDEL MEDICAL CENTER
CRITICAL CARE MEDICATION MANUAL
DEPARTMENT OF NURSING AND PHARMACY
Intravenous Haloperidol (Haldol®)
Major Indications
Rapid neuroleptization in patients exhibiting acute psychotic behavior
Mechanism of Action
Precise mechanism of action is unclear. Haloperidol appears to depress the central nervous
system at the subcortical level of the brain by inhibiting the reticular activating system as well as
antagonizing the CNS catecholamine (dopamine) receptors.
Pharmacokinetics
IV
IM
Onset of Effect
5-10 minutes
20-30 minutes
Peak Effect
20-30 minutes
50-60 minutes
Duration of Effect
4-5 hours
4-6 hours
Monitoring
Blood Pressure
Mental Status
Dosing and Administration*
IM / IV Push (over 1 minute) / IVPB
Mild Agitation:
Moderate Agitation:
Severe Agitation:
0.5-2 mg
2-5 mg
10-20 mg
May repeat bolus doses every 20-60 minutes until calm achieved, then administer 50% of
the maximum bolus dose required for good effect every 6 hours. Doses up to 1200 mg in
the 1st 24 hour period have been reported in the literature.
Continuous infusions, 100 mg haloperidol in 100 ml D5W, have been used in doses of 1-40
mg/hr
*IV administration is not FDA-approved, however, haloperidol lactate has been administered intravenously without increased
risk of adverse effects.
Haloperidol, reviewed 11/02
Adverse Effects
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Cardiac: Hypotension, hypertension, tachycardia, EKG changes (QT interval prolongation)
Heme: Mild and transient leukopenia
CNS: Extrapyramidal Symptoms (incidence is significantly lower with IV administration than
with oral administration): parkinsonian-type movements, akathisia, and dystonic
reactions
Tardive Dyskinesias: persistent rhythmic involuntary movements- symptoms continue
despite discontinuation of medication
Misc: laryngospasm, bronchospasm
Neuroleptic Malignant Syndrome (characterized by hyperpyrexia, severe hypertonicity of
skeletal muscles, diaphoresis, tachycardia, alterations in blood pressure, and
arrhythmias).
Syndrome can be fatal, haloperidol should be discontinued immediately and supportive
care established.
Comments
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4.
Haloperidol lowers the seizure threshold in patients with history of epilepsy and those patient in
acute alcohol withdrawal.
Haloperidol decanoate CANNOT be administered IV. If administering haloperidol, be sure
haloperidol lactate is used. Haloperidol decanoate should be administered via deep IM injection.
Concomitant use of haloperidol with other CNS depressants will produce additive effects.
There is considerable interindividual variation in the dose of haloperidol required to control
behavior. Doses should be titrated carefully and the lowest possible dose should be used to avoid
adverse effects.
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