For frail older patients with delirium, prioritise non-drug de-escalation and treating precipitating causes. If haloperidol is considered, use the lowest effective dose for the shortest time with ECG/electrolyte checks and movement/swallowing monitoring as indicated. Known QTc prolongation and Parkinson disease/dementia with Lewy bodies are critical contraindications; avoid labelling every liver/renal disorder as an absolute contraindication.

Scope: Only the statements identified above were checked. The remainder is historical teaching content, not a clinically authorised prescribing protocol.

Official source. Verify current BNF/BNFC, SmPC and local NHS policies before clinical use.

🩺 UK medication safety review — 5 November 2026

Delirium in frail or older adults is not a general rapid-tranquillisation indication. Treat underlying causes and use non-pharmacological de-escalation first. NICE CG103 supports considering short-term haloperidol only for distress or risk when non-drug measures fail or are inappropriate. Use the lowest clinically appropriate dose and the shortest course; dose and route are patient-specific and require current BNF/local prescribing verification. The MHRA warns of QT prolongation, extrapyramidal adverse effects, falls and dysphagia/aspiration. Check ECG and correct electrolytes where possible; avoid haloperidol in Parkinson's disease and dementia with Lewy bodies.

Sources: NICE CG103, MHRA haloperidol safety advice. Targeted safety correction, not a full review of psychiatric dosing; use current BNF and local specialist pathways.

⚠️ Use reduced doses in elderly and frail patients.
🚫 Avoid in Parkinson’s disease and dementia with Lewy bodies, or established QT-prolongation contraindications; other comorbidities require drug-specific precautions and specialist review.
💡 Non-drug strategies first: orient the patient (well-lit room, visible clock), involve family, reassurance.

📘 About

Haloperidol is a typical antipsychotic (neuroleptic).
Main uses: acute confusion (delirium), acute psychosis, mania, severe agitation, nausea/vomiting.

⚙️ Mode of Action

Dopamine D₂ receptor antagonist in mesolimbic pathways.
Reduces positive psychotic symptoms, agitation, and vomiting reflex (chemoreceptor trigger zone).
But also blocks nigrostriatal dopamine → extrapyramidal side effects (EPS).

💊 Indications & Example Doses

🤢 Severe Nausea/Vomiting: 1–2 mg IM.
🧓 Delirium in older/frail adults: Only if distressed or at risk after de-escalation has failed or is inappropriate; use the lowest clinically appropriate dose under current BNF/local policy. Avoid fixed repeat-dose schedules without reassessment.
🌀 Acute psychosis or mania: Doses and routes depend on the indication, age, comorbidity and specialist protocol; check current BNF and psychiatric guidance.
😟 Anxiety: Haloperidol should not be presented as a routine treatment for isolated anxiety; seek an indication-appropriate approach.
🚨 Severe behavioural disturbance: Do not apply a universal starting-dose range; use a locally approved rapid-tranquillisation policy and specialist assessment, and do not transfer those doses to delirium in frail older adults.

⚠️ Always check ECG (QTc) before initiation and review renal/hepatic function.

🚫 Contraindications

Parkinson’s disease, Lewy body dementia.
Known QTc prolongation (including congenital long-QT syndrome), relevant ventricular arrhythmias and concomitant QT-prolonging medicines: check the current SmPC for exact contraindications.
Hepatic or renal impairment requires individual dose/monitoring assessment; these are not universal absolute contraindications.
Epilepsy, alcohol-withdrawal states and other complex psychiatric presentations require specialist assessment, not a simple one-size-fits-all rule.
Review all SmPC precautions, drug interactions and patient-specific neurological risks before treatment.

⚠️ Side Effects

🧠 Extrapyramidal symptoms (rigidity, tremor, akathisia, dystonias).
🚨 Neuroleptic Malignant Syndrome (rare, life-threatening).
💤 Sedation, drowsiness, insomnia.
📉 Hypotension, dizziness, prolonged QT.
👁️ Glaucoma, blurred vision.
GI upset, antimuscarinic effects (dry mouth, constipation, urinary retention).

📖 References

BNF – Haloperidol

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Haloperidol 💊 ✅

🩺 Source-checked UK safety correction — 5 November 2026