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
15 mg aripiprazole	300 mg Abilify Maintena
20 mg aripiprazole	400 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 mg x 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 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.

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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