What are dose conversions from oral to injectable for the long-acting injectable (LAI) antipsychotic medications available in the U.S.?

Dose Conversion of Oral Aripiprazole to Aripiprazole LAI

PO Dose

LAI/IM Dose

10 mg aripiprazole

300 mg Abilify Maintena

15 mg aripiprazole

400 mg Abilify Maintena

20 mg aripiprazole

600 mg Abilify Maintena

Recommended available dose formulations include 300 and 400 mg pre-filled vial kits (PI recommended maximum 400 mg).

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. VA Pharmacy Benefits Management Services. (2016). Aripiprazole long-acting-injection (Abilify Maintena, ARISTADA) [National Drug Monograph].   
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

Dose Conversion of Oral Aripiprazole to Aripiprazole LAI

PO Dose

LAI/IM Dose

10 mg aripiprazole 

441 mg Aristada every 4 weeks

15 mg aripiprazole

662 mg Aristada every 4 weeks

15 mg aripiprazole

882 mg Aristada every 6 weeks

15 mg aripiprazole

1064 mg Aristada every 8 weeks

20 mg aripiprazole

882 mg Aristada every 4 weeks

Recommended available dose formulations include 441, 662, 882, and 1064 pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. VA Pharmacy Benefits Management Services. (2016). Aripiprazole long-acting-injection (Abilify Maintena, ARISTADA) [National Drug Monograph].   
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

Dose Conversion of Oral Fluphenazine to Fluphenazine Decanoate LAI

PO Dose - Fluphenazine

LAI/IM Dose - Fluphenazine Decanoate

Initial LAI dose

Suggested 6.25 mg every 2 weeks
(or calculated at 1.25 mgx PO dose every 3-6 weeks)

10 mg daily

12.5 mg (0.5 ml) every 3 weeks
[can be given every 2 weeks]

20 mg daily

25 mg (1 ml) every 3 weeks

30 mg daily

37.5 mg (1.5 ml) every 3-6 weeks

40 mg daily

50 mg (2 ml) every 3-6 weeks

Typical dose: 6.25-25 mg every 2-4 weeks.

General conversion formula: For each 10 mg/day PO, give 12.5 mg decanoate every 3 weeks. Increase by 12.5 mg increments if doses >50 mg needed. 

Recommended available dose formulations include 25mg/ml strength, in 5ml multiple does vials.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. APP Pharmaceuticals. (2010). Fluphenazine decanoate, injection usp. 
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841 

Dose Conversion of Oral Haloperidol to Haloperidol Decanoate LAI

PO Dose - Haloperidol

LAI/IM Dose - Haloperidol Decanoate

Initiate LAI dose – for stabilized or elderly patients

10-15x PO dose

Maintenance LAI dose – for stabilized or elderly patients

10-15x PO dose every 4 weeks

Initiate LAI dose – for patients with high relapse risk / higher dose

At 10-20x PO dose

Maintenance LAI dose – for patients with high relapse risk / higher dose

10-15x PO dose every 4 weeks

Dose Conversion of Oral Paliperidone to Paliperidone Palmitate LAI

PO Dose 

LAI/IM Dose

Initiate LAI doses

Loading doses – 234 mg day 1, followed by 156 mg day 8, followed by maintenance dose 5 weeks after first injection

< 3 mg paliperidone

39 mg Invega Sustenna every 4 weeks

3 mg paliperidone

78 mg Invega Sustenna every 4 weeks

6 mg paliperidone

117 mg Invega Sustenna every 4 weeks

9 mg paliperidone

156 mg Invega Sustenna every 4 weeks

12 mg paliperidone

234 mg Invega Sustenna every 4 weeks

Recommended available dose formulations include 39 mg, 78 mg, 117 mg, 156 mg, and 234 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

Dose Conversion of Oral Paliperidone to Paliperidone Palmitate 12-week LAI

PO Dose 

LAI/Invega Sustenna Dose **Stabilization with Invega Sustenna required prior to initiation of Invega Trinza

LAI/Invega Trinza Dose

< 3 mg paliperidone

39 mg Invega Sustenna every 4 weeks

3 mg paliperidone

78 mg Invega Sustenna every 4 weeks

273 mg Invega Trinza every 12 weeks

6 mg paliperidone

117 mg Invega Sustenna every 4 weeks

410 mg Invega Trinza every 12 weeks

9 mg paliperidone

156 mg Invega Sustenna every 4 weeks

546 mg Invega Trinza every 12 weeks

12 mg paliperidone

234 mg Invega Sustenna every 4 weeks

819 mg Invega Trinza every 12 weeks

Recommended available dose formulations include 273 mg, 410 mg, 546 mg, and 819 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

Dose Conversion of Oral Risperidone to Risperidone Microspheres LAI

PO Dose 

LAI/IM Dose

1 mg daily

12.5 mg every 2 weeks

2-3 mg daily

25 mg every 2 weeks

3-5 mg daily

37.5 mg every 2 weeks

4-5 mg daily

50 mg every 2 weeks

Recommended available dose formulations include 12.5 mg, 25 mg, 37.5 mg, and 50 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Bai, Y.M., Chen, T.T., Chen, J-Y., Chang, W-H., Wu, B., Hung, C.H., & Lin, W.K. (2007). Equivalent switching dose from oral risperidone to risperidone long-acting injection: A 48-week randomized, prospective, single-blind pharmacokinetic study. Journal of Clinical Psychiatry, 68(8), 1218-1225. doi: 10.4088/jcp.v68n0808.
2. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.
3. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

Dose Conversion of Oral Risperidone to Risperidone Subcutaneous LAI

PO Dose

LAI/SC Dose

3 mg daily

90 mg every 4 weeks

4 mg daily

120 mg every 4 weeks

Recommended available dose formulations include 90 mg and 120 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Indivior. (2018). Perseris dosing and administration.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

Dose Conversion of Oral Olanzapine to Olanzapine LAI

PO Dose

LAI/IM Dose – Initial 8 weeks

LAI/IM Dose – Maintenance

10 mg daily

210mg every 2 weeks or
405mg every 4 weeks

150 mg every 2 weeks or
300 mg every 4 weeks

15 mg daily

300 mg every 2 weeks

210 mg every 2 weeks or
405 mg every 4 weeks

20 mg daily

300 mg every 2 weeks

300 mg every 2 weeks

Recommended available dose formulations include 210 mg, 300 mg and 405 mg pre-filled powder for suspension vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Eli Lilly. (2019). Zyprexa Relprevv prescribing information. 
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841