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 injection

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Fluphenazine

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Summary for Haldol

Prescription only

Haloperidol injection is an antipsychotic medication that's used to treat schizophrenia. It's a long-acting injection that's given into the muscles monthly by a healthcare provider. It's also available as a shorter-acting injection that's typically given in a hospital setting to people who are experiencing agitation related to schizophrenia. The most common side effects of haloperidol injection are movement-related side effects, such as rigid muscles, tremors, and trouble speaking.

Indications for Haldol

Schizophrenia

Pros and Cons for Haldol

Pros

Typically given monthly
Low risk for weight gain, compared to some other antipsychotics
Available as a lower-cost, generic medication

Cons

Needs to be injected
Higher risk of movement-related side effects compared to atypical antipsychotics
Can't be used in children

Common Side Effects for Haldol

Stiff or rigid muscles, tremors, trouble speaking, and other parkinsonism symptoms (31%)

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