Haloperidol
Acute agitation, Psychosis, Delirium, Intractable nausea/vomiting
Indications
- Acute agitation
- Psychosis
- Delirium
- Intractable nausea/vomiting
Adult dosing
- agitation im: dose: 5; unit: mg; route: IM; interval: May repeat q30-60min; max 20mg/day; fixed: true; b52: dose: 5; unit: mg; route: IM; interval: Combine with lorazepam 2mg + diphenhydramine 50mg (B52); fixed: true; delirium: dose: 0.5; unit: mg; route: IV/PO; interval: q8h; use lowest effective dose; fixed: true
Pediatric dosing
- agitation: dose: 0.05; unit: mg/kg; maxDose: 5; route: IM; interval: May repeat once; weightBased: true
Contraindications
- QTc prolongation
- Parkinson disease
- Dementia with Lewy bodies
Clinical pearls
- B52 = Benadryl 50mg + Haldol 5mg + Ativan 2mg IM — classic ED agitation cocktail
- Monitor QTc — risk of torsades especially IV route
- High EPS risk — dystonia, akathisia. Give diphenhydramine prophylactically
- NOT recommended for delirium prevention (no benefit per MIND-USA trial)
Source and review
- APA Practice Guidelines; MIND-USA Trial, NEJM 2018. Last reviewed: 2024-11-01