Converting Antipsychotics: Oral to Long-Acting Injectables

CONVERTING ANTIPSYCHOTICS: ORAL TO LONG-ACTING INJECTABLES

 

(1) Fluphenazine (Prolixin®) PO to Fluphenazine Decanoate:

 

METHOD 1:

  • 10mg PO = 12.5mg IM
  • 1.25 X PO daily dose = equivalent decanoate dose.
  • Administer Q2-3wks.
  • Continue ½ PO daily dose X 1st few months.

METHOD 2:

  • ↑ Decanoate dose over 4wks & ↓ PO dose over 4-8wks as follows:

 

ORAL DECANOATE (Administer Q 2 weeks)
ORAL DOSE (mg/day) ↓ DOSE OVER (weeks) INITIAL DOSE (mg) TARGET DOSE (mg) DOSE OVER (weeks)
5 4 6.25 6.25 0
10 4 6.25 12.5 4
20 8 6.25 12.5 4
30 8 6.25 25 4
40 8 6.25 25  4

 

(2) Haloperidol (Haldol®) PO to Haloperidol Decanoate:

 

METHOD 1:

  • 10-15 X daily PO dose = IM equivalent decanoate dose (Round to nearest 50mg).
  • Administer Q4wks.
  • Continue ½ PO daily dose X 1st few months.
  • ↓ PO dose over 3 months. Accelerate taper if side effects occur.

Method 2:

  • Admin equivalent decanoate dose Q4wks. Continue PO X 1 month (or discontinue within 7 days of 2nd injection).

 

(3) Risperidone PO to Risperdal Consta®:

 

Oral Risperidone Dose

Risperidone Long-Acting Injection

3 mg/day or less 25 mg
> 3 mg/day- 5 mg/day or less 37.5 mg
> 5 mg/day  50 mg

Source: J Clin Psychiatry. 2007 Aug;68(8):1218-25.

 

(4) Risperdal Consta® IM to Invega Sustenna® IM

 

Risperdal Consta® IM (mg/2 wks) Invega Sustenna® IM (mg/month)
12.5 39
25 78
37.5 117
50 156
75  234

 

(5) Paliperidone (Invega®) PO to Invega Sustenna® IM

 

Invega ER® PO (mg/day) Invega Sustenna® IM (mg/month)
3 39-78
6 117
9 156
12  234

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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