Indications: schizophrenia; psychotic or manic symptoms of schizoaffective disorder

Cautions: predisposition to gastro-intestinal obstruction; elderly patients with dementia and risk factors for stroke; prolactin-dependent tumours; cataract surgery (risk of intraoperative floppy iris syndrome)

Breast-feeding: avoid—present in milk

Contra-indications: hepatic impairment caution in severe impairment

Renal impairment: initially 3 mg once daily if eGFR 50–80 ml/minute/1.73 m2 (max. 6 mg once daily); initially 1.5 mg once daily if eGFR 10–50 ml/minute/1.73 m2 (max. 3 mg once daily); avoid if eGFR less than 10 ml/minute/1.73 m2

Pregnancy: use only if potential benefit outweighs risk—toxicity in animal studies; if discontinuation during pregnancy is necessary, withdraw gradually

Side Effects: hypertension, respiratory disorders (including infection), epistaxis, appetite changes, sleep disorders, anxiety, depression, malaise, urinary disorders, arthralgia, myalgia, toothache, oedema; less commonly hypoaesthesia, paraesthesia, taste disturbances, elevated plasma-triglyceride and -cholesterol concentrations, visual disorders, tinnitus, alopecia; rarely intestinal obstruction, pancreatitis, pulmonary embolism, inappropriate antidiuretic hormone secretion, rhabdomyolysis, intra-operative floppy iris syndrome.

Dose: ADULT over 18 years, 6 mg once daily in the morning, adjusted if necessary in increments of 3 mg over at least 5 days; Always take with breakfast or always take on an empty stomach By deep intramuscular injection into the deltoid muscle, 150 mg on day 1, then 100 mg on day 8, then adjusted at monthly intervals according to response; Following the second dose, monthly.

maintenance doses can be administered into either the deltoid or gluteal muscle; for missed doses see product literature.

Maintenance, Oral usual range 3–12 mg daily recommended maintenance dose 75 mg (range 50–150 mg) monthly.