Routeof Administration

A. Oral administration is available for all antipsychotics and some are available in liquid form for elderly patients or to increase compliance in patients who "cheek" their medications and later spit them out.

B. Long-acting intramuscular (depot) neuroleptics such as Haldol and Prolixin decanoate are useful for non-compliant patients.

1. Haldol decanoate should be started at twenty times the daily oral dose in the first month of treatment, divided into three or four injections given over a seven-day period. For example, a patient receiving 20 mg of oral haloperidol per day would be given 400 mg of decanoate. The dose may be reduced by 25% in each of the next two months such that the maintenance dose is 200 mg every 30 days.

2. Prolixin decanoate should be started at 25 mg every two weeks with the dose adjusted up to 50 mg every two weeks if necessary.

3. Once a patient has received one or two injections, the oral antipsychotic can be discontinued.

C. There are no currently available short-acting IM formulations of atypical antipsychotics although this is currently under development. Haloperidol (Haldol) and chlorpromazine (Thorazine) are often used in IM form to treat acutely agitated psychotic patients. Thorazine is usually given 25-50 mg IM with close monitoring of blood pressure. Haldol 5-10 mg is often given in conjunction with 1 -2 mg of IM Ativan which provides sedation.

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