⚠️ Use reduced doses in elderly and frail patients.
🚫 Avoid in: Lewy body dementia, Parkinsonism, prolonged QTc >470 ms, acute alcohol withdrawal, epilepsy.
💡 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.
- 🧓 Agitation in elderly (delirium): 0.5–1.5 mg PO/IM every 8–12h.
- 🌀 Acute Psychosis/Mania: 0.5–3 mg PO/IM tds (max 20 mg/day).
- 😟 Severe Anxiety (short-term): 0.5 mg PO every 8–12h.
- 🚨 Severely Disturbed Patients: 2–10 mg PO/IM initially, titrate up to 18 mg/day.
⚠️ Always check ECG (QTc) before initiation and review renal/hepatic function.
🚫 Contraindications
- Parkinson’s disease, Lewy body dementia.
- Prolonged QTc (>470 ms), history of arrhythmia.
- Liver or renal failure.
- Epilepsy, acute alcohol withdrawal, severe depression.
- Myasthenia gravis.
⚠️ 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