Serenace (Haloperidol)
Also sold as: Serenace, Haloperdol (Torrent), Halonil, Senorm, Halopace (depot)
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 0.5mg, 1.5mg, 5mg, 10mg +3
Indications
- Schizophrenia and schizoaffective disorder (acute and maintenance)
- Acute mania (adjunct or short-term)
- Psychotic agitation (emergency setting — IV/IM)
- Delirium (especially hyperactive delirium — palliative, ICU)
- Tourette syndrome (tics)
- Nausea and vomiting (refractory — off-label; IV in palliative care)
Adult Dosing
Schizophrenia (acute)
5–10 mg PO BD–TDS or 5–10 mg IM 2-hourly as needed (max 30 mg IM/day in acute setting)
Titrate based on response. Elderly: start 0.5–1 mg PO.
Schizophrenia (maintenance)
3–15 mg PO daily (divided)
Ongoing; depot 50–200 mg IM every 4 weeks for compliance
Delirium (ICU/palliative)
0.5–2 mg IV/IM every 4–6 hours; titrate cautiously
QT monitoring mandatory (QTc > 500 ms — reduce or stop)
Pediatric Dosing
Paediatric use: child psychiatrist supervision mandatory
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No specific adjustment — hepatically metabolised; start low in severe CKD |
Hepatic Adjustment
Start with lower doses in hepatic impairment — reduced metabolism, prolonged action
Pregnancy & Lactation
Pregnancy: Category C
Use only when benefit outweighs risk. Neonatal extrapyramidal signs (limb movements, irritability) reported when used near delivery. Neonatal withdrawal. If antipsychotic needed in pregnancy, lowest effective dose preferred.
Lactation: Caution
Excreted in breast milk — monitor infant for sedation and extrapyramidal signs. Generally considered second choice; quetiapine or olanzapine preferred if needed.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| QT-prolonging drugs (amiodarone, quinidine, sotalol, macrolides, antifungals, ondansetron at high dose) | Additive QT prolongation — risk of torsades de pointes. ECG monitoring essential. | Major |
| CNS depressants (benzodiazepines, opioids, alcohol) | Additive sedation and respiratory depression | Major |
| Lithium | Encephalopathy syndrome reported (rare) — hallucinations, confusion, fever; monitor closely | Major |
| Carbamazepine, phenytoin, rifampicin | Reduce haloperidol levels — may need dose increase | Moderate |
| Levodopa, dopamine agonists | Mutual antagonism — haloperidol worsens Parkinson's; dopamine agonists worsen psychosis | Major |
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Side Effects
Common
- Extrapyramidal side effects (EPS — akathisia: restlessness; dystonia: muscle spasms; parkinsonism: tremor, rigidity, bradykinesia)
- Sedation
- Hypotension (especially IM/IV)
- Dry mouth
- Constipation
- Weight gain (less than olanzapine)
- Hyperprolactinaemia (galactorrhoea, sexual dysfunction)
Serious / Discontinue If
- Neuroleptic malignant syndrome (NMS) — rare, life-threatening: fever > 38°C, severe rigidity, altered consciousness, autonomic instability; CK markedly elevated; stop immediately
- Tardive dyskinesia (involuntary movements — after prolonged use; may be irreversible)
- QT prolongation and torsades de pointes
- Laryngeal/pharyngeal dystonia (emergency — airway compromise)
- Seizures (lowers seizure threshold)
Contraindications
- Parkinson's disease / Lewy body dementia (catastrophic worsening)
- Known QTc prolongation
- CNS depression
- Coma
- Pheochromocytoma
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Serenace 5mg | RPG Life Sciences | 30 tab ₹55 |
| Senorm 5mg | Sun Pharma | 30 tab ₹48 |
| Halonil 5mg | Intas | 30 tab ₹45 |
| Haloperidol Injection 5mg/mL | Neon Labs | Amp ₹22 |
Monitoring Required
- ECG (QTc) at baseline and with dose changes or addition of QT drugs
- Extrapyramidal symptom rating scale (AIMS for tardive dyskinesia)
- Metabolic parameters (glucose, lipids — less problematic than atypicals)
- Prolactin (if galactorrhoea or sexual dysfunction)
- Temperature and CK if NMS suspected
Patient Counseling Points
- Take with food to reduce stomach upset
- Restlessness or inability to sit still (akathisia) is a side effect — tell your doctor, not a reason to stop medicine without advice
- Rise slowly from bed — low blood pressure on standing is common initially
- ⚠️ If you develop high fever with severe muscle stiffness, confusion — go to emergency immediately (NMS)
- Do not stop suddenly — psychosis can return; taper under medical supervision
- Depot injection (monthly): does not need daily pill taking — can improve compliance significantly
Stop Googling drug references mid-consultation
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Clinically reviewed by: Dr. Vikas Desai, MD (Psychiatry), Senior Consultant Psychiatrist
Last reviewed: 2026-04-01
References
- WHO Essential Medicines List — Haloperidol
- NICE Psychosis and Schizophrenia Guidelines 2014
- BNF — Haloperidol
- Cochrane — Haloperidol vs Atypical Antipsychotics
- ICMR National Mental Health Programme Guidelines