Haloperidol long-acting

Depot antipsychotics (e.g., haloperidol decanoate, fluphenazine decanoate, and risperidone long-acting injection) can be used for maintenance therapy of bipolar disorder with noncompliance or treatment resistance. 

Haloperidol and fluphenazine decanoate should be administered by a deep, Z-track IM method. Long-acting risperidone is injected by deep IM injection in the gluteus maximus, but Z-tracking is not necessary. 

Haloperidol decanoate (Haldol Decanoate) Antipsychotic Inj 50,100 mg/mL 25-100 mg IM q4 weel long acting. Reduce dose in elderly extrapyramidal symptoms, alpha-blocking effects, high doses may prolong QT interval. 

Among the difficulties in pharmacological treatment is the frequent non-compliance. The biggest determinant of compliance is the quality of a patient s relationship with his doctor. But a further way to handle the issue has involved the development of long acting products (depot neuroleptics), even though their effectiveness in the absolute or compared to oral preparations has not been adequately explored. The most commonly used depot agents are fluphenazine and haloperidol decanoate (see David et al., 2004). 

For patients with chronic psychotic symptoms who do not comply with a daily medication regimen, a long-acting depot preparation should be considered after stabilization with oral medication. Fluphenazine, haloperidol, and risperidone are the only long-acting injectable antipsychotic medications currently available in the United States. 

Zissis NP, Psaras M, Lyketsos G. Haloperidol decanoate, a new long-acting antipsychotic, in chronic schizophrenics double-blind comparison with placebo. Curr Ther Res 1982 31 650-655. 

Kane JM. Dosage strategies with long-acting injectable neuroleptics, including haloperidol decanoate. J Clin Psychopharmacol 1986 6(suppl) 20S-23S. 

Haloperidol is used as an antipsychotic and occasionally for control of acute agitation in the intensive care unit. It is can also be useful in the treatment of phencyclidine abuse. It produces a cataleptic state with little drowsiness and has minimal effects on blood pressure and respiration. It is a long-acting drug with a half-life of about 18 hours. It is available in oral and injectable preparations. In large doses extrapyramidal side effects may occur. 

Haloperidol s long-acting intramuscular formulation lasts up to 4 weeks, whereas some other long-acting intramuscular antipsychotics may only last up to 2 weeks... 

Medication may be seen by the patient as intrusive and controlling or, alternatively, as comforting—a transitional, object-like extension of the therapist. Patients will be prone to interpret the medication in psychotic ways, especially when they are more symptomatic (and more in need of medication). When compliance remains a significant problem, consideration may be given to using one of the long-acting injectable forms of the antipsychotics (haloperidol decanoate or fluphenazine de-canoate). 

Haloperidol +++ + + High potency, butyrophenone, long-acting depot forms available [... 

It is important to simplify the treatment regimen and to ensure that the patient is receiving the drug. In cases of suspected severe and dangerous noncompliance or with failure of oral treatment, the patient can be treated with injections of fluphenazine decanoate, haloperidol decanoate, or other long-acting preparations, including risperidone microspheres. 

Maintenance with injections of the decanoate ester of fluphenazine or haloperidol every 2—4 weeks, or with long-acting risperidone microspheres every 2—3 weeks, can be very effective. However, an expectation of superiority of long-acting injected antipsychotics is not well supported by available studies, most of which involve randomization of patients who already are largely cooperative with long-term oral treatment. 

A study found that the steady-state plasma levels of haloperidol 6 to 15 mg daily were not signifieantly ehanged in 3 patients by long-acting propranolol, in incremental doses up to 480 mg daily. ... 

In the second study, which lasted 2 years, long-acting injectable risperidone (n = 50) was compared with oral risperidone (n = 47) and haloperidol (n = 47) [130. Prolactin-related adverse events occurred in four of those who received injectable risperidone galactorrhea in one amenorrhea... 

Suzuki H, Gen K. The influence of switching from haloperidol decanoate depot to risperidone long-acting ii ection on the clinical symptoms and cognitive function in schizophrenia. Hum Psychopharmacol 2012 27(5) 470-5. 

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