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Haldol decanoate should be administered by an intramuscular injection into the buttocks. The recommended interval between doses is 4 weeks. The starting dose of Haldol decanoate should be 10-15 times the patient’s previous daily dose of oral haloperidol. However, the maximum initial dose should be no more than 100mg. A lower initial dose is recommended and then the dose can be gradually adjusted according to response. Close clinical supervision is recommended during the initial period of dose adjustment in order to minimize side effects.
The intravenous route is not FDA approved and is generally not recommended except when no other alternatives are available. Intravenous administration appears to be associated with a higher risk of QT prolongation and torsade de pointes (TdP) than other forms of administration. The manufacturer recommends ECG monitoring for QT prolongation and arrhythmias if IV administration is required. A dose in the range of 1 to 5 mg IV has been suggested, with the dose being repeated at 30 to 60 minute intervals, if needed. A maximum IV dose has not been established. The lowest effective dose should be used in conjunction with conversion to oral therapy as soon as possible.