Long-acting injectable antipsychotics: what, when, and how

Current guidelines for the treatment of patients with schizophrenia advocate that patients receive treatment with a long-acting injectable (LAI) antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence. Available LAI formulations in the United States include first-generation antipsychotics (fluphenazine decanoate and haloperidol decanoate), risperidone/paliperidone containing products (risperidone microspheres, paliperidone palmitate, and risperidone subcutaneous), aripiprazole containing products (aripiprazole monohydrate and aripiprazole lauroxil), and olanzapine pamoate. LAI antipsychotics can address the guesswork about adherence status and patients may prefer them if they are offered this as a choice, including individuals early in their disease course. Additional approved indications in the United States for LAI antipsychotics include bipolar I disorder maintenance treatment for risperidone microspheres and aripiprazole monohydrate, and schizoaffective disorder for paliperidone palmitate once monthly. Differences and similarities among the different products are discussed, including guidance regarding optimal treatment selection. Tips are provided to enhance effective patient communication to maximize the likelihood of acceptance of this treatment modality.

Automated summary

Guidelines recommend that patients with schizophrenia should opt for long-acting injectable (LAI) antipsychotic medications to eliminate guesswork about adherence status and potentially improve patient preference, especially for individuals early in their disease course. Approved indications in the US include bipolar disorder maintenance treatment and schizoaffective disorder treatment for specific LAI antipsychotic products. Various differences and similarities among the available products are discussed along with guidance on optimal treatment selection, as well as tips for effective patient communication to enhance acceptance of this treatment modality.