Propranolol with Haloperidol Interaction Details

Brand Names Associated with Propranolol

Brand Names Associated with Haloperidol

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 15, 2023

Interaction Effect

An increased risk of hypotension and cardiac arrest

Interaction Summary

A case report described 3 hypotensive episodes and 2 cardiopulmonary arrests in a patient who received haloperidol and propranolol concomitantly on 3 separate occasions. Alpha-receptor binding by haloperidol and an additive relaxant effect on peripheral blood vessels by haloperidol and propranolol possibly blunting sympathetic heart stimulation is a postulated mechanism for this interaction. The authors advise caution in coadministering haloperidol and propranolol or other beta blockers. Monitoring the patient for signs of hypotension is warranted.

Severity

Major

Onset

Rapid

Evidence

Probable

How To Manage Interaction

Concomitant use of haloperidol and propranolol may increase the risk of hypotension and cardiac arrest. Caution is advised when coadministering haloperidol and propranolol or other beta blockers. Monitor the patient for signs of hypotension.

Mechanism Of Interaction

Unknown

Literature Reports

A) A case report described 3 hypotensive episodes and 2 cardiopulmonary arrests with concomitant haloperidol and propranolol use in a 48-year-old woman with schizophrenia and hypertension. Two years after starting haloperidol 20 mg/day and trichlormethiazide 4 mg/day, the patient was admitted with psychosis due to discontinuing haloperidol. Her blood pressure (BP) was 205/100 mmHg. Propranolol 80 mg was initiated followed by haloperidol 10 mg nine hours later. Ninety minutes later, she was unresponsive with shallow breathing and a BP of 80/0 mmHg. The patient recovered and was discharged with haloperidol 30 mg/day and trichlormethiazide 4 mg/day. Ten months later, the patient was admitted with agitation after stopping her medicine. Haloperidol 10 mg was administered. Ten hours later, she was given haloperidol 10 mg and propranolol 40 mg. Hypotension and cardiopulmonary arrest occurred 2.5 hours later. She was discharged the next day with loxapine 25 mg/day, trichlormethiazide 4 mg/day, and propranolol 80 mg twice per day. Five months later, the patient presented with acute psychosis and a BP of 210/110 mmHg. Because her chart could not be located to assess prior treatment, she was given propranolol 80 mg and 15 minutes later, haloperidol 10 mg. Hypotension and cardiac arrest occurred 30 minutes later. After discharge, she continued to be successfully maintained on trichlormethiazide 4 mg/day, propranolol 80 mg twice daily, and loxapine 30 mg/day. A postulated mechanism is alpha-receptor binding by haloperidol and an additive relaxant effect on peripheral blood vessels by haloperidol and propranolol that may blunt sympathetic heart stimulation .

Propranolol Overview

• Propranolol is used to treat high blood pressure, irregular heart rhythms, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremor, and hypertrophic subaortic stenosis (a heart muscle disease). It is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart attack. Propranolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Haloperidol Overview

• Haloperidol is used to treat psychotic disorders (conditions that cause difficulty telling the difference between things or ideas that are real and things or ideas that are not real). Haloperidol is also used to control motor tics (uncontrollable need to repeat certain body movements) and verbal tics (uncontrollable need to repeat sounds or words) in adults and children who have Tourette's disorder (condition characterized by motor or verbal tics). Haloperidol is also used to treat severe behavioral problems such as explosive, aggressive behavior or hyperactivity in children who cannot be treated with psychotherapy or with other medications. Haloperidol is in a group of medications called conventional antipsychotics. It works by decreasing abnormal excitement in the brain.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.