Haloperidol is a first-generation antipsychotic medication traditionally used in the treatment of psychosis, mood disorders, Tourette syndrome, and intractable nausea and vomiting.

Evidence for its analgesic properties was first discussed in the 1970s. Recent studies support these findings.

Haloperidol can be administered orally, intravenously, intramuscularly, or subcutaneously.

First-line or add-on therapy for:

• Gastroparesis
• Migraine
• Cannabinoid hyperemesis syndrome
• Palliative pain control, nausea, and vomiting
• Chronic pain syndromes unrelieved by other analgesic modalities

Novel indications for analgesia:

• Abdominal migraines
• Cancer pain, chemotherapy/radiation-induced emesis
• Neuropathic pain
• Opioid-induced hyperalgesia

Comatose states from any cause

Known allergy or hypersensitivity to haloperidol

Parkinsonism

Severe intoxication with ETOH or other CNS depressants

Nausea/vomiting/gastroparesis: 0.5 to 2 mg IV OR 2 to 5 mg IM/PO

Pain adjunct: 2 to 5 mg IV OR 5 to 10 mg IM/PO

Decanoate formulation should be administered IM only. Select route-appropriate formulation.

Anticholinergic symptoms: dry mouth, constipation, blurred vision

Extrapyramidal symptoms: akathisia, Parkinsonism, tardive dyskinesia, dystonia

Hypotension

Neuroleptic malignant syndrome

QT prolongation (IV administration increases the risk)

Sedating effects

See detailed side effects

Because haloperidol is relatively novel for pain and nausea/vomiting, document the rationale for its use and ideally that you discussed its use with patient (risk vs benefit).

Chart ECG in appropriate cases (see below).

Patients with a history of heart disease or prolonged QTc and those taking QTc-prolonging medications should get an ECG before administration. Consider telemetry.

Use caution with patients taking anticonvulsants or with known seizure disorder. Haloperidol can lower the seizure threshold.

It is considered high risk in geriatrics (patients older than 65 years) per Beers criteria.

There is evidence of increased mortality in elderly patients with dementia-related psychosis.

Caution in pregnancy.

Avoid in women who are nursing.