USE OF HALOPERIDOL IN PREGNANCY

Haloperidol is a butyrophenone derivative ‘typical’ antipsychotic used in the treatment of a range of psychotic disorders including schizophrenia, psychoses, mania, agitation, anxiety, and violent or dangerously impulsive behaviour. Haloperidol is also licensed for the treatment of motor tics, intractable hiccups, nausea and vomiting, and Tourette syndrome.

Although haloperidol exposures are included in a number of studies which report fetal outcomes for cohorts of pregnant women exposed to various antipsychotics, the percentage and absolute number of haloperidol exposures in each of these cohorts is generally very small and separate analysis for haloperidol is rarely undertaken. 

The data on which to assess fetal risk of exposure to haloperidol in human pregnancy are mainly derived from published case reports, an uncontrolled case series, a controlled cohort study, and are extremely limited.   

No studies have been published which investigate the risk of spontaneous abortion, stillbirth/IUD or neurodevelopmental impairment following in utero exposure to haloperidol specifically. Although the available data do not suggest that haloperidol use in pregnancy is associated with an increased risk of congenital anomaly or abnormal birth weight, increased risks for these outcomes have been reported for antipsychotics as a group and can therefore not be discounted. Furthermore, data are available which have also suggested increased risks of preterm delivery and neurodevelopmental impairment following typical antipsychotic exposure. However, the possibility of data confounding cannot be excluded.

Adverse neonatal effects including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorders have been reported following maternal haloperidol use in pregnancy. As such, delivery should be planned in a unit with adequate neonatal facilities for the management of PNAS.

It is important to ensure that maternal mental health is treated appropriately. Where a patient is stabilised on haloperidol, either prior to conception or during pregnancy, the risk of discontinuing or changing medication, or reducing the dose, should be carefully weighed against the risk of relapse of the maternal condition. Where clinically appropriate, clinicians are encouraged to discuss the advantages and disadvantages of continued haloperidol use during pregnancy with the patient. Where the benefit of continued treatment is considered to outweigh any potential or known risks, haloperidol may be prescribed for use in pregnancy. Where use of haloperidol is clinically indicated in an emergency situation, it should not be withheld on account of pregnancy.

Exposure to haloperidol at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.