Long Acting Injectable: Haloperidol Decanoate (PART 1).

Q: HALDOL Decanoate 50 and HALDOL Decanoate 100 are the long-acting forms of HALDOL (haloperidol). Patients with haldol plasma levels over ___ ng/ml had a significantly reduced relapse rate compared with patients with plasma levels below this plasma threshold level

 

BEFORE SCROLLING DOWN ==>

SUBMIT YOUR ANSWERS FIRST 🙂

.

.

.

.


PHARMACOKINETICS:

  • Peak Levels Reached by: 6 days after the injection.

  • Half Life: 3 weeks.

  • Steady State Plasma Concentration: Achieved by third or fourth dose = 3-4 months. 


THERAPEUTIC PLASMA LEVEL:

  • For a single dose of 100 mg haloperidol decanoate monthly the minimal steady state value is about 4 ng/ml. (3)

  • There is no known relationship between plasma level and clinical response, but patients with plasma levels over 4 ng/ml had a significantly reduced relapse rate compared with patients with plasma levels below this plasma ‘threshold’ level. (5)

  • Oral Haloperidol: optimum patient response associated with plasma haloperidol levels of 4.2- 11.0 ng/ml for the first 2 weeks of treatment. (4) 

 

AIM FOR LEVEL BETWEEN 4-11 NG/ML.

 


CONVERTING Haloperidol (Haldol®) PO to Haloperidol Decanoate:

    • 10-15 X daily PO dose = IM equivalent decanoate dose (Round to nearest 50mg).

    • Administer Q 4wks.

    • Continue ½ PO daily dose X 1st few months.

  • PO dose over 3 months. Accelerate taper if side effects occur.


MANAGING MISSED DOSE OF HALDOL DEC

 

(A) <6 WEEKS SINCE LAST INJECTION:

  • Give next scheduled dose of Haldol Dec as soon as possible.

(B) >6 – 12 WEEKS SINCE LAST INJECTION:

  • Give next scheduled dose of Haldol Dec as soon as possible.

  • Oral Haloperidol should be used only for recurrence of symptoms.

  • Monitor closely for side effects after Haloperidol Decanoate injection (esp. in first 1 week)

(C) >13 WEEKS SINCE LAST INJECTION:

  • First stabilize on oral haloperidol and initiate decanoate once stable.


PART 2 OF THIS POST:- click here.

 


Source:

  1. Haldol Decanoate injection [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; February 2017.
  2. Am J Psychiatry. 1981;138(3): 365-367.
  3. Int Pharmacopsychiatry. 1982;17(4):238-46.
  4. Psychopharmacology (Berl). 1983;81(4):354-6.
  5. Eur Neuropsychopharmacol. 1995;5 Suppl:55-8.
  6. http://www.dhhs.saccounty.net/BHS/Documents/Provider-Forms/Medication-Info-Sheets/Medication%20Conversion%20Chart.pdf
  7. Current Psychiatry. 2018 July;17(7):10-12,14-19,56.

Dr. Harvinder Singh, M.D. (Admin)


Physician’s Guide for Clinical Psychiatry course contains following chapters on Long-Acting Injectables:

Subscribe to Physician’s Guide for Clinical Psychiatry Course for detailed access to 220+ chapters:

Course Details: https://psychiatryeducationforum.teachable.com/p/physicians-guide-for-clinical-psychiatry

Related Articles

Responses

Comments are closed.