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

Dose conversion (oral to LAI) for Abilify Maintena (aripiprazole monohydrate LAI):

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 (oral to LAI) for Aristada (aripiprazole lauroxil LAI):

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 (oral to LAI) for Prolixin Decanoate (fluphenazine decanoate): 

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 (oral to LAI) for Haldol Decanoate (haloperidol decanoate):

Dose Conversion of Oral Haloperidol to Haloperidol Decanoate LAI

PO Dose - Haloperidol

LAI/IM Dose - Haloperidol Decanoate

Initiate LAI dose – for elderly, debilitated, or stable on low doses of oral haloperidol 

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

20x PO dose

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

10-15x PO dose every 4 weeks

General conversion formula: For each 5 mg/day oral, give 50-75 mg Decanoate every 4 weeks.

Recommended available dose formulations include 50 mg/ml strength, in 3 ml multiple dose vials or 100 mg/ml strength, in 5 ml multiple dose vials.

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

References:
1. Janssen Pharmaceuticals. (2019). Haloperidol decanoate for IM injection only.
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
3. HALDOL DECANOATE USPI 

Dose conversion (oral to LAI) for Invega Sustenna (paliperidone palmitate LAI), Invega Trinza (paliperidone palmitate 12-week LAI), or Invega Hafyera (paliperidone palmitate 6-month LAI):

Paliperidone Conversion from Oral to LAI Formulations

PO Dose

LAI/Invega Sustenna Dose

LAI/Invega Trinza*    

LAI/Invega Hafyera**

<3 mg Paliperidone

39 mg Invega Sustenna every 4 weeks

N/A

N/A

3 mg Paliperidone

78 mg Invega Sustenna every 4 weeks

273 mg Invega Trinza every 12 weeks

N/A

6 mg Paliperidone

117 mg Invega Sustenna every 4 weeks

410 mg Invega Trinza every 12 weeks

N/A

9 mg Paliperidone

156 mg Invega Sustenna every 4 weeks

546 mg Invega Trinza every 12 weeks

1,092 mg Invega Hafyera every 6 months

12 mg Paliperidone

234 mg Invega Sustenna every 4 weeks

819 mg Invega Trinza every 12 weeks

1,560 mg Invega Hafyera every 6 months

*Stabilization with at least four months (4 injections) of Invega Sustenna required prior to initiation of Invega Trinza.

**Stabilization with at least four months (4 injections) of Invega Sustenna or at least one three month cycle (1 injection) of Invega Trinza prior to initiation of Invega Hafyera. 

If administering a strong CYP3A4/P-glycoprotein inducer, considering managing the patient using Paliperidone extended-release tablet. 

References:

1.  Stahl, S.M. (2017).  The prescribers 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/10.71176/appi.books.9780890424841 

3.  INVEGA SUSTENNA USPI, Section 2.8: Instructions for Use; Section 17: How Supplied/Storage and Handling

4.  INVEGA TRINZA USPI, Section 2.2: Schizophrenia

5.  INVEGA HAFYERA USPI, Section 2.4: Instruction for Preparation and Administration

Dose conversion (oral to LAI) for Risperdal Consta (risperidone microspheres LAI): 

Dose Conversion of Oral Risperidone to Risperidone Microspheres LAI

PO Dose 

LAI/IM Dose

1 mg daily

12.5 mg (injection volume of 2 ml) every 2 weeks

2-3 mg daily

25 mg (injection volume 2 ml) every 2 weeks

3-5 mg daily

37.5 mg (injection volume 2 ml) every 2 weeks

4-5 mg daily

50 mg (injection volume 2 ml) 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, in patients with hepatic or renal impairment, or in patients who have a history of poor tolerability to psychotropic medications. 

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
4. RISPERDAL CONSTA USPI Section 2.1: Schizophrenia; Section 2.2: Bipolar Disorder; Section 2.3: General Dosing Information; Section 2.8: Instructions for Use  

Dose conversion (oral to LAI) for Perseris (risperidone subcutaneous LAI): 

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 (oral to LAI) for Zyprexa Relprevv (olanzapine LAI): 

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

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