Some information presented within this Center of Excellence was created in collaboration with the California Department of State Hospitals (DSH). This includes that the content has been specifically aligned to the DSH’s medication guidelines (DSH Psychotropic Medication Operational Procedures, appended to DSH Policy Directive 3400). These medication guidelines are applicable only to the DSH settings and inclusion within this resource does not indicate that they must be followed in any non-DSH settings. The medication guidelines included in this resource are those of DSH and do not necessarily represent the views, policy(ies), and/or position(s) of the American Psychiatric Association (APA).
Dose conversion (oral to LAI) for Abilify Maintena (aripiprazole monohydrate LAI):
Dose Conversion of Oral Aripiprazole to Aripiprazole LAI | |
Oral Dose | LAI/IM Dose |
Aripiprazole 15 mg | Abilify Maintena 300 mg |
Aripiprazole 20 mg | Abilify Maintena 400 mg |
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 or 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 3. California Department of State Hospitals Psychotropic Medication Operational Procedures | |
Dose conversion (oral to LAI) for Aristada (aripiprazole lauroxil LAI):
Dose Conversion of Oral Aripiprazole to Aripiprazole LAI | |
Oral Dose | LAI/IM Dose |
Aripiprazole 10 mg | Aristada 441 mg every 4 weeks |
Aripiprazole 15 mg | Aristada 662 mg every 4 weeks |
Aripiprazole 20 mg | Aristada 882 mg every 6 weeks |
Aripiprazole 20 mg | Aristada 1064 mg every 8 weeks |
Recommended available dose formulations include 441, 662, 882, and 1064 pre-filled vial kits. Dose reduction may be necessary for CYP450 interactions or 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 3. California Department of State Hospitals Psychotropic Medication Operational Procedures | |
Dose conversion (oral to LAI) for Prolixin Decanoate (fluphenazine decanoate):
Dose Conversion of Oral Fluphenazine to Fluphenazine Decanoate LAI | |
Oral Dose - Fluphenazine | LAI/IM Dose - Fluphenazine Decanoate |
Initial LAI Loading Dose | Suggested 12.5-25 mg weekly x 3 weeks |
Maintenance LAI Dose | Most patients will be well maintained on a fluphenazine decanoate dose of 12.5 to 75 mg IM every 2 weeks Overall dose range can be between 12.5-75 mg every 2 weeks, max dosing 75 mg/week Dose should be adjusted per fluphenazine trough plasma concentration |
10mg Daily | ~ 12.5 mg (0.5 ml) every 2 weeks |
20 mg Daily | ~ 25 mg (1 ml) every 2 weeks |
30 mg Daily | ~ 37.5 mg (1.5 ml) every 2 weeks |
40 mg Daily | ~ 50 mg (2 ml) every 2 weeks |
Recommended available dose formulations include 25mg/ml strength, in 5ml multiple does vials. Dose reduction may be necessary for CYP450 interactions or 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 3. Meyer, Jonathan M., and Stephen M. Stahl. The clinical use of antipsychotic plasma levels: stahl's handbooks. Cambridge University Press, 2021. 4. DSH Medication Protocols. (2025). Chapter 9 | |
Dose conversion (oral to LAI) for Haldol Decanoate (haloperidol decanoate):
Dose Conversion of Oral Haloperidol to Haloperidol Decanoate LAI | |
Oral Dose - Haloperidol | LAI/IM Dose - Haloperidol Decanoate |
Initiate LAI dose – for patients with high relapse risk / higher dose | 10x PO dose for 3 weeks |
Maintenance LAI dose | 20x PO dose 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 or side effect intolerance. References: 1. Janssen Pharmaceuticals. (2019). Haloperidol decanoate for IM injection only. 2. HALDOL DECANOATE USPI 3. DSH Psychotropic Medication Operational Procedures. (2025). Chapter 9. 4. Meyer, Jonathan M., and Stephen M. Stahl. The clinical use of antipsychotic plasma levels: stahl's handbooks. Cambridge University Press, 2021. | |
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 | |||
Oral Dose | LAI/Invega Sustenna Dose | LAI/Invega Trinza* | LAI/Invega Hafyera** |
Paliperidone <3 mg | Invega Sustenna 39 mg every 4 weeks | N/A | N/A |
Paliperidone 3 mg | Invega Sustenna 78 mg every 4 weeks | Invega Trinza 273 mg every 12 weeks | N/A |
Paliperidone 6 mg | Invega Sustenna 117 mg every 4 weeks | Invega Trinza 410 mg every 12 weeks | N/A |
Paliperidone 9 mg | Invega Sustenna 156 mg every 4 weeks | Invega Trinza 546 mg every 12 weeks | Invega Hafyera 1,092 mg every 6 months |
Paliperidone 12 mg | Invega Sustenna 234 mg every 4 weeks | Invega Trinza 819 mg every 12 weeks | Invega Hafyera 1,560 mg 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 6. California Department of State Hospitals Psychotropic Medication Operational Procedures. | |||
Dose conversion (oral to LAI) for Risperdal Consta (risperidone microspheres LAI):
Dose Conversion of Oral Risperidone to Risperidone Microspheres LAI | |
Oral Daily Dose | LAI/IM Dose |
1 mg daily | 12.5 mg (injection volume of 2 ml) every 2 weeks |
2 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 5. Taylor, D.M., Barnes, T.R.E, & Young, A.H. (2021). The Maudsley prescribing guidelines in psychiatry (14th ed.). Wiley Blackwell. 6. California Department of State Hospitals Psychotropic Medication Operational Procedures | |
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