Haldol (haloperidol) vs. Ativan (lorazepam): What's the difference?

  • Haloperidol and Ativan (lorazepam) are used to treat different types of psychiatric disorders.
  • Haloperidol is used to treat schizophrenia, acute psychosis, and for tics and vocal utterances of Tourette's syndrome.
  • Ativan is used to manage anxiety disorders, for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, for short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, before anesthesia for sedation, to prevent and treat alcohol withdrawal, and to treat seizures (status epilepticus).
  • A brand name for haloperidol is Haldol.
  • Haloperidol and Ativan belong to different drug classes. Haloperidol is an antipsychotic medication and Ativan is a benzodiazepine.
  • Side effects of haloperidol and Ativan that are similar include dizziness, sedation, erectile dysfunction, sleep disturbances (insomnia), and extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes; muscle stiffness, restlessness, Parkinsonism).
  • Side effects of haloperidol that are different from Ativan include hyperactivity, tiredness, nausea, weight gain, menstrual irregularities, swelling of breast tissue in males (gynecomastia), dry mouth, vomiting, constipation, and dizziness on standing during the first few weeks of treatment.
  • Side effects of Ativan that are different from haloperidol include weakness, unsteadiness, depression, amnesia, loss of orientation, headaches, low blood pressure (hypotension), changes in appetite, and sleep apnea.
  • Do not stop using haloperidol or Ativan suddenly, or you could have unpleasant withdrawal symptoms.

What is Haloperidol? What is Ativan?

Haloperidol is an antipsychotic medication used for treating schizophrenia, acute psychosis, and for tics and vocal utterances of Tourette's syndrome. Haloperidol interferes with the effects of neurotransmitters in the brain. Haloperidol blocks receptors for the neurotransmitters (specifically the dopamine and serotonin type 2 receptors) on the nerves. As a result, the nerves are not "activated" by the neurotransmitters released by other nerves.

Ativan (lorazepam) is a benzodiazepine used to manage anxiety disorders, for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, for short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, before anesthesia for sedation, to prevent and treat alcohol withdrawal, and to treat seizures (status epilepticus). It is thought that Ativan and other benzodiazepines may act by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain to reduce activity. Other benzodiazepines include diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and flurazepam (Dalmane).

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What are the side effects of haloperidol and Ativan?

Haloperidol

The most common side effects associated with Haldol are:

  • extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes, muscle stiffness, akathisia, Parkinsonism),
  • dizziness,
  • hyperactivity,
  • tiredness, and
  • nausea.

Other important side effects are:

  • sedation,
  • weight gain,
  • erectile dysfunction,
  • menstrual irregularities,
  • insomnia,
  • gynecomastia,
  • dry mouth,
  • vomiting, and
  • constipation

Haldol may cause a condition called "orthostatic hypotension" during the early phase of treatment (first week or two). Orthostatic hypotension causes patients to become dizzy upon arising from a lying or sitting position because of a drop in blood pressure.

Haldol also may cause abnormal heart beats, sudden death, seizures, decreases in red and white blood cells, and withdrawal symptoms.

Elderly patients with dementia-related psychosis and treated with antipsychotic drugs such as Haldol are at an increased risk of death.

Ativan

The most common side effects associated with Ativan are:

  • Sedation
  • Dizziness
  • Weakness
  • Unsteadiness

Other side effects include:

  • A feeling of depression
  • Amnesia
  • Loss of orientation
  • Headaches
  • Sleep disturbances
  • Low blood pressure (hypotension)
  • Impotence (erectile dysfunction, ED)
  • Changes in appetite
  • Sleep apnea

Possible serious side effects include:

  • Extrapyramidal symptoms
  • Respiratory depression
  • Suicidal ideation/attempt
  • Seizures
  • Depression

WARNING

Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.

What is the dosage of haloperidol vs. Ativan?

Haloperidol
• The recommended oral dose for schizophrenia is 0.5-5 mg two or three times daily up to a maximum dose of 30 mg daily. The lactate solution dose is 2-5 mg every 4-8 hours as needed by intramuscular injection. The lactate solution may also be administered by intravenous injection at 1-2 mg every 2-4 hours and titrated to effect. The maximum single injection dose is 50 mg and the maximum daily dose is 500 mg daily. The dose for the decanoate solution is 10-20 times the daily oral dose once monthly by intramuscular injection. The decanoate solution should not be administered intravenously.
• The recommended dose for treating Tourette's syndrome is 0.5-5 mg orally two or three times daily.
Ativan
• The dose of lorazepam is tailored to the patient's needs.
• The usual dose for treating anxiety is 2-6 mg orally every 8 to 12 hours as needed.
• Insomnia is treated with 2-4 mg giv

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What drugs interact with haloperidol and Ativan?

Haloperidol
Haldol causes sedation, and sedation may be greater if Haldol is taken with alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs for example:
• diazepam (Valium)
• lorazepam (Ativan)
• clonazepam (Klonopin)
• alprazolam (Xanax)
The narcotic class of pain medications and its derivatives for example:
• oxycodone and acetaminophen (Percocet)
• hydrocodone/acetaminophen (Vicodin)
• Dilaudid
• Codeine,
• propoxyphene (Darvon)
The tricyclic class of antidepressants for example:
• amitriptyline (Elavil, Endep)
• imipramine (Tofranil)
• desipramine (Norpramin)
Some antihistamines for example:
• hydroxyzine (Atarax, Vistaril)
• diphenhydramine (Benadryl)
• Tavist
Certain antihypertensive medications for example:
• clonidine (Catapres)
• propranolol (Inderal)
Carbamazepine (Tegretol) may increase the elimination of Haldol, rendering the Haldol less effective. Rifampin (Rifadin) may decrease the elimination of Haldol, increasing the risk of side effects from Haldol.
Ativan
• Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but caution should be used if Ativan and loxapine are used together.

Is haloperidol or Ativan safe to use while pregnant or breastfeeding?

Haloperidol
• Neonates exposed to antipsychotics during the 3rd trimester of pregnancy may develop withdrawal symptoms and extrapyramidal symptoms.
• Haldol is secreted into breast milk. It should not be used while breast feeding.
Ativan

Ativan and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Ativan is best avoided if at all possible in the first trimester and probably throughout pregnancy.
Ativan is excreted in human milk and should be avoided during pregnancy.

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Summary

Haldol (haloperidol) and Ativan (lorazepam) are used to treat different types of psychiatric disorders. Haloperidol is used to treat schizophrenia, acute psychosis, and for tics and vocal utterances of Tourette's syndrome. Ativan is used to manage anxiety disorders, for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, for short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, before anesthesia for sedation, to prevent and treat alcohol withdrawal, and to treat seizures (status epilepticus).

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Medically Reviewed on 7/30/2019
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