LAI Haloperidol

Q; 24 years old male is getting discharged from ICU to floor after resolution of his acute schizophrenia. Previously patient has been on home Haloperidol. Psychiatry service changed his medicine to Long Acting Injectable (LAI) form of Haloperidol. Pharmacy service called ICU team to confirm as the dose sounds unusual. The prescribed LAI dose of Haloperidol  is usually? (select one)

A) equivalent to daily dose of Haloperidol

B) half the daily dose of Haloperidol

C) double the daily dose of Haloperidol

D) 10-20 times the daily dose of Haloperidol

Answer: D

The dose of haloperidol when prescribed as LAI is 10 to 20 times the previous daily dose of oral haloperidol. It is usually given as once a month. The maximum dose in this regard is 100 mg, regardless of previous dose of daily requirement. If dose needs to be exceeded, it should be handled by an expert of the field. Also, LAI form is usually prescribed when patient has been on daily haloperidol for about 8-12 weeks.

Again, specialized person i.e., psychiatry service should be consulted at each step of drug modification/overlap etc.

#psychiatry

References:

1. Ereshefsky L, Saklad SR, Jann MW, et al. Future of depot neuroleptic therapy: pharmacokinetic and pharmacodynamic approaches. J Clin Psychiatry 1984; 45:50.

2. Jann MW, Ereshefsky L, Saklad SR. Clinical pharmacokinetics of the depot antipsychotics. Clin Pharmacokinet 1985; 10:315.

3. Correll CU, Kim E, Sliwa JK, Hamm W, Gopal S, Mathews M, Venkatasubramanian R, Saklad SR. Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview. CNS Drugs. 2021 Jan;35(1):39-59. doi: 10.1007/s40263-020-00779-5. Epub 2021 Jan 28. PMID: 33507525; PMCID: PMC7873121.