BNF dose changes to haloperidol and haloperidol decanoate (depot)
In August 2018 dose changes were made to the haloperidol and haloperidol decanoate monographs as part of the BNF electronic monthly updates.
Of particular relevance was the increase in maximum dose for haloperidol IM to 20mg for ‘Rapid control of severe acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder [when oral therapy is not appropriate]’. This is now in line with the haloperidol IM manufacturer’s recommended maximum dose.
This also reflects the current Summary of Product Characteristics (SPC) recommendation of a 1:1 dose conversion rate between oral and IM injection rather than the previous 5:3 dose conversion rate respectively, which was recommended by the BNF.
Table 1 shows some of the relevant updated indications and doses in the electronic BNF for Adults for the haloperidol monograph.
Haloperidol decanoate monograph
The main changes include:
- A specified maximum dose of 300mg every four weeks; andan individually assessed benefit-risk for doses over 200mg every four weeks
- Dosing interval of four weeks, although the BNF does note that a change to the dosing interval may be needed
- An emphasis on dose equivalence and conversion with oral:
- “the consensus is that 2 mg per day of oral haloperidol is approximately equivalent to 15 mg per week of haloperidol decanoate depot injection”
- With oral supplementation: total dose for both combined not to exceed equivalent of 20mg/day (oral haloperidol)
Table 2 shows some of the relevant updated indications and doses in the electronic BNF for Adults for the haloperidol decanoate monograph.
A small test dose of haloperidol decanoate is still recommended to rule out undesirable side effects.
(Please go to https://bnf.nice.org.uk/ for the full update to both monographs).
Please note: the revised recommended doses for Haloperidol have only been updated in the electronic BNF. The doses in the printed version of the BNF (76 edition, September 2018 – March 2019) have not yet been amended. Clinicians need to be clear about which version of the BNF is being used until the next printed version is published.