Haloperidol

About Haloperidol

The tablet label says haloperidol’s precise mechanism has not been clearly established; the decanoate label adds that its effect in schizophrenia could come from blocking dopamine D2 receptors. The tablets and concentrate are labeled for psychotic disorders, for the tics and vocal utterances of Tourette’s disorder in children and adults, and, only after psychotherapy or non-antipsychotic medicines have failed, for severe combative, explosive behavior problems and short-term treatment of hyperactive children with conduct disorders; they are not meant for children under 3. Adults usually start at 0.5 to 2 mg two or three times a day, or 3 to 5 mg for severe symptoms. The short-acting injection, labeled for schizophrenia, goes into a muscle and is replaced by an oral form as soon as practical. The decanoate is for adults with schizophrenia already stable on oral haloperidol: a health professional injects it deep into a muscle every four weeks, at a dose based on the previous daily oral dose.

The boxed warning says older adults with dementia-related psychosis treated with antipsychotics have a higher risk of death, and haloperidol is not approved for them. Sudden death, QT prolongation and torsades de pointes, a dangerous heart rhythm, have been reported, and higher than recommended doses and injection into a vein, which is not approved, appear to raise the risk; the labels advise particular caution with low potassium or magnesium, other QT-prolonging drugs, heart abnormalities, an underactive thyroid or inherited long QT syndrome. Other warnings cover tardive dyskinesia (lasting involuntary movements, with the highest risk in older adults, especially women), neuroleptic malignant syndrome (high fever, rigid muscles, confusion), falls, low white blood cell counts, seizures and a serious brain reaction in a few people also taking lithium. It must not be used in coma or severe central nervous system depression, in Parkinson’s disease or after an allergic reaction to it; the injection labels add dementia with Lewy bodies. Stiffness, tremor, restlessness and muscle spasms are frequent, often in the first few days.

The FDA lists every Haldol product as discontinued, including Haldol Decanoate. The decanoate label calls for an ECG and blood salts (potassium, calcium, phosphorus and magnesium) before starting, and people who have had low white cell counts need frequent blood counts in the first months. Like other antipsychotics it raises prolactin, which can cause breast discharge, missed periods or impotence, and babies exposed late in pregnancy can have movement or withdrawal symptoms after birth.

Taking Haloperidol

How to take it

Tablets and concentrate are usually taken two or three times a day, at around the same times each day. Measure the concentrate with the dropper marked in milligrams that comes with the bottle. Get up slowly, and do not drive until you know how it affects you.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

At room temperature, tightly closed, away from heat, moisture and light, out of reach of children; do not let the concentrate freeze. Use a take-back program rather than flushing it.

Interactions to know about

Rifampin can sharply lower its levels, and other QT-prolonging medicines add to the heart rhythm risk. Alcohol should be avoided, and it can strengthen the effects of opioids, anesthetics and other sedatives. With lithium the prescriber watches for early nerve toxicity, and with anticholinergic medicines pressure inside the eye can rise.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Haloperidol differs from pharmacy to pharmacy

Haloperidol tablets are an old generic made by many companies, so a cash quote is mostly the pharmacy’s dispensing fee and markup, and a dose written as two 5 mg tablets instead of one 10 mg tablet raises the count. The concentrate comes from fewer makers than the tablets. The injections are given by a health professional; when a pharmacy fills the decanoate for a clinic visit, the quote depends on whether it comes as single-dose vials or a multiple-dose vial.

Ways to pay less for Haloperidol without insurance

• Ask whether haloperidol tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask the prescriber to write each dose as the fewest tablets of one strength, for example one 10 mg tablet rather than two 5 mg tablets.
• Ask for a ninety-day supply once your dose is stable; it is not a controlled substance.
• For the decanoate, ask the clinic whether it supplies the dose or a pharmacy needs to fill it.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Haloperidol

1. 1.Do I need an ECG or blood tests for potassium and magnesium while I take it?
2. 2.Which movement side effects, fever or muscle stiffness mean I should call right away?
3. 3.Does it interact with my lithium, heart rhythm medicines or other drugs that affect the QT interval?
4. 4.How do I measure my dose of the concentrate accurately?

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