Haldol vs. Prolixin for Bipolar Disorder: Important Differences and Potential Risks.

Key takeaways

Haloperidol (Haldol) and fluphenazine (Prolixin) are both typical antipsychotics used to treat psychosis, but they have some differences. Haloperidol is mainly used for schizophrenia and is available as oral forms, as well as a long-acting injection given monthly or a short-acting injection for acute agitation. Fluphenazine treats various psychotic disorders and comes in both short-acting forms (tablets, liquid, injection) taken multiple times a day and a long-acting injection given every 4 to 6 weeks. Both medications may cause weight gain and movement-related side effects. Both medications can cause serious side effects like neuroleptic malignant syndrome and are not recommended for older adults with dementia-related psychosis. Fluphenazine can also raise prolactin levels, leading to additional side effects like milky nipple discharge and menstrual issues. Both medications are available as lower-cost generics.

Haloperidol

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Fluphenazine

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Summary for Haldol

Prescription only

Haloperidol is a typical antipsychotic used to treat several behavioral and psychiatric conditions in adults and children. This medication is taken by mouth, typically 2 to 3 times per day. Side effects of haloperidol include sleepiness, dizziness, and dry mouth.

Indications for Haldol

Psychotic and behavioral disorders
Tourette syndrome in adults and children
Hyperactivity in children

Pros and Cons for Haldol

Pros

Available as a tablet and a liquid
Available as a lower-cost, generic medication
Works well to treat several behavioral and psychiatric conditions
Can be used in children

Cons

Can have lots of problematic side effects compared to newer antipsychotics
Needs to be taken two to three times per day
Can cause dangerous withdrawal symptoms if suddenly stopped
Might cause drowsiness, which can affect normal daily activities

Common Side Effects for Haldol

Drowsiness
Headache
Tremor
Muscle spasms
Abnormal muscle movement
Mood changes (anxiety, depression)
Trouble sleeping
Restlessness

Warnings for Haldol

Higher risk of death in older people with dementia-related psychosis
Life-threatening abnormal heart rhythm (QT prolongation)
Difficulty controlling body movements
Neuroleptic malignant syndrome (NMS)
Higher risk of falls
Pneumonia
Low white blood cell counts
Harm to unborn babies

Summary for Prolixin

Prescription only

Fluphenazine is a typical antipsychotic and is used to treat conditions that cause psychosis. It's available as short-acting fluphenazine hydrochloride (tablets, liquid, injection) that's typically taken by mouth or injected 3 to 4 times a day. It also comes as long-acting fluphenazine decanoate (injection) that's usually given every 4 to 6 weeks. Side effects of this medication include drowsiness and movement problems. Brand name Prolixin is no longer available.

Indications for Prolixin

Psychotic disorders

Pros and Cons for Prolixin

Pros

Available as a lower-cost generic medication
Comes as a tablet, liquid, or injection (both short- and long-acting)
Dose can be easily adjusted based on individual needs

Cons

Long-term use can raise the risk of permanent movement problems
Not safe for use in older adults with dementia-related psychosis
Might not be a safe option if you've had a bad reaction to similar medications (e.g., chlorpromazine (Thorazine), thioridazine (Mellaril))

Common Side Effects for Prolixin

Dystonia (uncontrollable muscle contractions): neck spasms, difficulty swallowing and breathing, sticking your tongue out
Involuntary movements (especially of the face or mouth)
Changes in blood pressure
Weight changes
Fluid retention (holding onto fluid)
Nausea
Constipation
Loss of appetite
Dry mouth
Headache
Salivation, drooling
More sweating
Frequent urination