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haloperidol decanoate

Long-acting injectable antipsychoticLAI available

Brands: HALDOL DECANOATE

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

  • What is haloperidol decanoate?

    Haloperidol decanoate (Haldol Decanoate) is a long-acting injectable formulation of haloperidol used for schizophrenia maintenance. It is often considered when relapse risk is driven by inconsistent daily dosing and a scheduled injection visit is a better fit than pills.

  • What is HALDOL DECANOATE?

    HALDOL DECANOATE is a brand name for haloperidol decanoate.

  • What is HALDOL DECANOATE (haloperidol decanoate) used for?

    Label indications include: Schizophrenia (maintenance treatment).

  • What drug class is HALDOL DECANOATE (haloperidol decanoate)?

    Long-acting injectable antipsychotic.

  • What is the mechanism of action of HALDOL DECANOATE (haloperidol decanoate)?

    Long-acting injectable formulation of haloperidol (high-potency dopamine D2 antagonist) designed for monthly maintenance dosing in schizophrenia when scheduled injections support adherence.

  • What strengths does HALDOL DECANOATE (haloperidol decanoate) come in?

    Long-acting depot injection: deep intramuscular injection, typically administered monthly (q4wk).

  • Is HALDOL DECANOATE (haloperidol decanoate) a controlled substance?

    No — it is not scheduled as a controlled substance under U.S. federal law.

  • How is haloperidol decanoate started as a long-acting injectable (LAI)?

    Many teams maintain a short oral overlap during conversion to prevent a coverage gap while depot concentrations rise. Missed-dose management is time-sensitive and should be documented at initiation.

Snapshot

  • Class: Long-acting injectable antipsychotic
  • Common US brands: HALDOL DECANOATE
  • Long-acting injectable formulation available.
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-30

Label indications

Schizophrenia (maintenance treatment).

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Clinical Highlights

Haloperidol decanoate (Haldol Decanoate) is a long-acting injectable formulation of haloperidol used for schizophrenia maintenance. It is often considered when relapse risk is driven by inconsistent daily dosing and a scheduled injection visit is a better fit than pills. This page focuses on the depot product. For the oral parent medication (broader indications and short half-life), see the haloperidol overview. For interval comparisons across depot options, see the LAI Navigator.

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  • Compared with many second-generation antipsychotics (SGAs), haloperidol decanoate generally has low metabolic burden (weight gain and dysglycemia), but a higher risk of EPS and tardive dyskinesia. QTc prolongation risk is a practical constraint, especially in patients with other QT-prolonging medications.
  • Pharmacokinetics are slow-moving: plasma concentrations rise after injection, peak around day 6, then decline with an apparent half-life of about 3 weeks. Steady state can take 2–4 months, so dose adjustments may take weeks to fully translate into clinical change.
  • The compare view can help compare depot options; the evidence feed tracks curated reading for this formulation.
  • Schizophrenia (adults): long-acting maintenance formulation.

Dosing & Formulations

Deep intramuscular depot injection, typically administered monthly (q4wk). Labeled schedules and injection technique differ from oral haloperidol; confirm product-specific administration guidance. Conversion from oral haloperidol is individualized. Label guidance commonly cites an initial monthly dose around 10–15× the total daily oral dose, with a maximum first injection dose limit (larger initial conversions may be split into two injections separated by several days).

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  • Many teams maintain a short oral overlap during conversion to prevent a coverage gap while depot concentrations rise. Missed-dose management is time-sensitive and should be documented at initiation.
  • Dose adjustments are slower than with oral therapy because steady state takes months; clinicians often reassess over multiple injection cycles before deciding a regimen is ineffective.

Monitoring & Risks

Boxed warning: increased mortality in elderly patients with dementia-related psychosis (antipsychotic class warning). EPS and tardive dyskinesia are key risks. Routine movement-disorder monitoring (e.g., AIMS) is commonly used, especially in high-risk patients and during the first months after dose increases.

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  • QTc: consider baseline ECG and periodic monitoring when clinically indicated (cardiac disease, electrolyte disturbances, or co-prescribed QT-prolonging drugs). Syncope or palpitations merit evaluation.
  • Prolactin-related adverse effects can occur (sexual dysfunction, menstrual changes, galactorrhea); monitoring is usually symptom-driven.
  • Sedation and orthostasis are generally less prominent than with some SGAs but can still occur, especially with polypharmacy.

Drug Interactions

Haloperidol is metabolized by CYP3A4 and CYP2D6; strong inhibitors can increase exposure and adverse effects, while strong inducers can reduce exposure and increase relapse risk. Additive QTc prolongation risk occurs with other QT-prolonging medications (some antidepressants, antiarrhythmics, macrolides, and fluoroquinolones). Risk is individualized to baseline QTc and clinical factors.

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  • Additive CNS depression can occur with alcohol, benzodiazepines, or sedative hypnotics; monitor falls risk and daytime functioning.
  • Combining dopamine-blocking agents increases EPS burden; use movement-disorder monitoring when combinations are unavoidable.

Practice Notes

Depot success is often about systems: reliable reminders, clear documentation of last injection date and site, and a written missed-dose plan reduce silent undertreatment. Because washout is slow, side effects can persist for weeks after dose changes or discontinuation. Teams often prioritize early recognition of akathisia/parkinsonism and prompt management rather than waiting for rapid washout.

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Long-acting injectable (LAI) options

  • Haloperidol decanoate
    Interval
    q4wk
    Oral overlap
    Consider short overlap during conversion
    Injection site
    Gluteal
    Notes
    • Typical conversion ~10–15× daily oral dose monthly; max first injection 100 mg (split remainder 3–7 days later)
    • Typical effective range 50–200 mg every 4 weeks; individualize

References

  1. HALDOL Decanoate prescribing information (DailyMed, 2025). — DailyMed (2025)
  2. Haloperidol tablets prescribing information — DailyMed (2025)
  3. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)
  4. Comparative Efficacy AND Tolerability OF 15 Antipsychotic Drugs IN Schizophrenia: A Multiple Treatments Meta Analysis — The Lancet (2013)Meta-analysisschizophreniaefficacy
  5. AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)
Haloperidol decanoate (HALDOL DECANOATE) — Summary — PsychMed