TaperCommunityhaloperidol
Boxed Warning
Increased mortality in elderly patients with dementia-related psychosis.
Haloperidol is a high-potency first-generation (typical) antipsychotic for schizophrenia, acute psychosis, and Tourette syndrome. Higher rates of EPS and tardive dyskinesia than atypicals; lower metabolic burden.
0.5mg, 1mg, 2mg, 5mg, 10mg, 20mg tablets; 2mg/mL solution; 5mg/mL injection; 50mg, 100mg/mL decanoate depot
Tablets: 0.5mg, 1mg, 2mg, 5mg, 10mg, 20mg; Oral solution: 2mg/mL; IM lactate: 5mg/mL; IM decanoate (depot): 50mg/mL, 100mg/mL
Category C
Potent D2 antagonist with little serotonin or histamine activity. The "clean" D2 blocker — drives both efficacy and EPS.
Very slow taper recommended. Watch for tardive movement disorders unmasking. Switching to atypical may smooth the taper for some patients.
High-potency D2 antagonists carry a meaningful tardive risk that is often irreversible. Discuss this risk explicitly during informed consent.
3-7 days (oral); weeks (depot)
2-4 weeks
4-8 weeks for acute symptoms
Tardive dyskinesia can emerge during or after taper and may be permanent
Toxicity
EPS (acute dystonia, parkinsonism, akathisia), tardive dyskinesia, NMS, QT prolongation, hyperprolactinemia, sedation. Tardive risk is substantial with chronic high-dose use.
Pharmacokinetics
Hepatic via CYP3A4, CYP2D6.
~92%
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