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

Key takeaways

Haloperidol (Haldol) and risperidone (Risperdal) are both antipsychotic medications, but they belong to different classes. Haloperidol is a typical antipsychotic, while risperidone is an atypical antipsychotic. Haloperidol is mainly used to treat schizophrenia and is available as oral forms, as well as a long-acting injection given monthly or a short-acting injection for acute agitation. Risperidone is also available in oral and injectable forms, and is used to treat schizophrenia, bipolar disorder, and irritability associated with autism. Both medications can cause movement-related side effects, such as rigid muscles and tremors, as well as weight gain and sleepiness. Both medications can be used in children. Both medications have serious risks, including a higher risk of death in older adults with dementia-related psychosis and the potential for neuroleptic malignant syndrome.

haloperidol injection

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Risperidone

(Risperdal)

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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 Risperdal

Prescription only

Risperidone (Risperdal) is an atypical antipsychotic that's used to improve mood, thoughts, and behaviors in people with schizophrenia, bipolar disorder, and autism. It's taken by mouth, typically once or twice daily. Common side effects of risperidone (Risperdal) include sleepiness, movement problems, and weight gain. Risperidone (Risperdal) can interact with some medications, such as certain antidepressants or blood pressure medications. Taking these medications together can make certain side effects worse.

Indications for Risperdal

Schizophrenia - people ages 13 years and older
Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older
Irritability associated with autism - children ages 5 to 17 years old

Pros and Cons for Risperdal

Pros

Taken by mouth
Available as a pill, dissolving tablet, and liquid
Can be used in both adults and children
Available as a lower-cost generic

Cons

Higher risk of sexual problems, compared to other atypical antipsychotics
Can cause weight gain
Can cause changes to sleep or movement problems
Shouldn't be mixed with alcohol

Common Side Effects for Risperdal

Adults:

Muscle stiffness, muscle tightening, difficulty with movement (25%)
Extreme sleepiness (11%)
Restlessness, trouble remaining still (9%)
Tremor (6%)
Dizziness (6%)
Nausea (5%)
Repetitive movements, abnormal postures (5%)

Children:

Extreme sleepiness (up to 56%)
Dizziness (up to 16%)
Nausea or vomiting (up to 16%)
Stomach pain (up to 16%)
Muscle stiffness, muscle tightening, difficulty with movement (up to 12%)
Heartburn (up to 10%)
Sore throat (up to 10%)

Warnings for Risperdal

Higher risk of death in older adults with dementia-related psychosis
Neuroleptic malignant syndrome
Difficulty controlling muscle movements (tardive dyskinesia)
Weight gain, higher blood sugar, and higher cholesterol levels
High prolactin levels
Changes in blood pressure and higher risk of falls
Risk of infection (from low white blood cell count)
Difficulty concentrating and extreme sleepiness
Seizures
Prolonged and painful erection
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only