This one-pager compares haloperidol decanoate, a first-generation long-acting injectable (LAI), with modern second-generation LAIs such as risperidone, paliperidone, olanzapine, and aripiprazole in the treatment of schizophrenia. While haloperidol remains effective and inexpensive, it carries significant risks of extrapyramidal symptoms and lower patient satisfaction. By contrast, newer LAIs show advantages in relapse prevention, tolerability, and adherence, with patients reporting greater acceptance and clinicians increasingly integrating them into shared decision-making. Although direct drug costs are higher, evidence suggests modern LAIs may reduce overall healthcare expenditures through fewer hospitalizations and improved continuity of care. Persistent barriers include clinician hesitancy, historical stigma, and reimbursement challenges, but overall the review concludes that second-generation LAIs provide superior outcomes and should be prioritized in most clinical contexts.
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