What are Long-Acting Injectable Antipsychotics? 

Long-acting injectable (LAI) antipsychotics have been shown to prevent psychosis relapse in patients with schizophrenia. To combat poor medication adherence, LAIs are a great option because they require dosing on monthly intervals instead of daily. Improved adherence can significantly improve quality of life, reduce hospitalizations, and outcomes among persons living with schizophrenia.

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Almost 7 million people in the U.S. take antipsychotic medications for various conditions to help relieve psychosis symptoms.

During psychosis, you might see, hear, or believe things that aren’t real. 

Antipsychotics are especially useful in treating schizophrenia (characterized by distortions in thinking, emotions, language, and behavior).

Schizophrenia affects more than 21 million people worldwide. Although there is no “cure,” most individuals who are prescribed antipsychotics experience some relief from symptoms and often live satisfying and productive lives.  

Antipsychotics must be taken regularly to control and reduce symptoms.

Research has shown that after an individual’s first hospitalization for schizophrenia, approximately 35% of patients stop taking their antipsychotic medications within 30 days of discharge, and more than 50% of patients stop them after 60 days. 

Unfortunately, when medications are not taken as prescribed, persons living with schizophrenia are at greater risk for relapse of psychosis, continued symptoms (such as hearing and seeing things that aren’t there), and suicide attempts. 

Not taking medication as prescribed (non-adherence) is complex and multi-factorial among persons living with schizophrenia.

Individuals may simply forget to take their medications, or think they are “well enough” and, therefore, don’t need them anymore. In other circumstances, individuals may not have the resources to afford their medications, may be homeless or have other reasons affecting their ability to take their medications.

Regardless of the situation, long-acting medications may be able to help persons living with schizophrenia. To learn more, keep reading! 

Long-acting Injectable Antipsychotics 

Persons living with schizophrenia typically have to take oral antipsychotic medications to help control their symptoms.

These medications may be taken once daily or more frequently, depending on individual circumstances. 

Long-acting medications, commonly called long-acting injectables (LAIs), are an alternative to some oral medications and work to improve symptoms like oral medications.

Unlike oral medications, which must be taken daily, LAIs can last 2, 4, or even 12 weeks depending on the medication with a single dose since they slowly release medicine into the bloodstream. 

As a result, LAIs can help persons living with schizophrenia stay on track with their medication plan. As a result, individuals will have a better chance of controlling their symptoms and staying out of the hospital.

Also, because LAIs slowly release medication over time, they have a lower risk of side effects and can improve quality of life and satisfaction with medication

As with all medications, there are some advantages and disadvantages that should be considered. Let’s explore these in more detail. 

Advantages of LAIs 

  1. Convenience for persons living with schizophrenia 
  2. Medications are administered as a single dose monthly, or every 2 – 3 months depending on the drug selected 
  3. Drug levels in the body usually are more stable compared to oral medications 
  4. Reduced risk of accidental or intentional overdose 
  5. Easier for healthcare professionals to follow-up with individuals on their medication adherence 
  6. Lower relapse rates and frequency of hospitalizations 
  7. Improved patient satisfaction 

Disadvantages of LAIs 

  1. Slow dose titration – meaning that it can take some time to get to the best dose to control symptoms 
  2. Your healthcare provider may still prescribe an oral medication during this time 
  3. Newer medications have improved this time frame and may not be as much of a concern 
  4. Can be harder to adjust the dose of LAIs 
  5. Individuals may find traveling to their doctor’s office or clinic to receive their injection burdensomely 
  6. Many community pharmacies (where allowed by law) are now able to administer LAIs antipsychotics, further improving access 
  7. Potential for pain or irritation at the injection site 

Which LAIs are Currently Available on the Market?

LAI 

Antipsychotic

Time between injections

Administration

Possible 

Side Effects

Abilify Maintena

(aripiprazole)

28-42 days

Into the muscle: deltoid or gluteal

Headache, trouble sleeping, muscle soreness

Haldol decanoate

(haloperidol)

28 days

Into the muscle: deltoid or gluteal

Trouble sleeping, agitation, uncontrolled muscle movement

Invega 

(paliperidone)

30-90 days

Into the muscle: deltoid or gluteal

Trouble sleeping, headache, uncontrolled muscle movement

Fluphenazine decanoate

7-21 days

Into the muscle: deltoid or gluteal 

Under the skin

Into the veins

Uncontrolled muscle movement

Risperdal

(risperidone)

28 days

Into the muscle: deltoid or gluteal

Tremor, headache, uncontrolled muscle movement, dizziness

Zyprexa Relprevv

(olanzapine)

14-28 days

Into the muscle: deltoid or gluteal

Drowsiness, uncontrolled muscle movement

How Effective are LAIs?

The Prevention of Relapse in Schizophrenia (PRELAPSE) study was designed to evaluate various treatments for individuals with schizophrenia without affecting their overall care.

The study had 489 participants who had early stages of the illness and had fewer than five years of antipsychotic medication use. 

Half of the participants received an LAI antipsychotic medication, aripiprazole, and the other half received oral treatment as usual. The study evaluated these individuals for two years. 

The PRELAPSE study showed that individuals with early-stage schizophrenia receiving the LAI antipsychotic medication had a 44% reduction in re-hospitalization risk.  

Another study evaluated 2488 patients with early-stage schizophrenia and found that LAI antipsychotics had a 64% lower relapse rate than an equivalent oral antipsychotic medication. 

An additional review looked at ten studies to determine whether LAI antipsychotics should be used in early schizophrenia and concluded that the use of LAIs in first psychosis episodes might be more effective than oral medication in controlling symptoms and relapse. 

Bottom Line 

Long-acting injectable antipsychotics have an important place in therapy. 

It may take a little longer to get to the right dose and symptoms to resolve, but studies have shown that individuals using these agents have improved satisfaction and results. 

LAIs are often underutilized but may be the key to medication adherence and significantly improving the quality of life for people living with schizophrenia. 

References: 

1. Brissos S, Veguilla MR, Taylor D, Balanzá-Martinez V. The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol. 2014;4(5):198-219. doi:10.1177/2045125314540297

2. Columbia University Medical Center. Benefits of Antipsychotics Outweigh Risks, Find Experts. https://www.eurekalert.org/pub_releases/2017-05/cumc-boa050217.php. Published 2017. Accessed 17 September 2020.

3. Kane JM, Schooler NR, Marcy P, et al. Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry. Published online July 15, 2020. doi:10.1001/jamapsychiatry.2020.2076

4. Klugh Kennedy W. When and how to use long-acting injectable antipsychotics. Current Psychiatry. 2012;11(8):40-43.

5. Opare-Addo MNA, Mensah J, Aboagye GO. A Case of Schizophrenia in a Young Male Adult with no History of Substance Abuse: Impact of Clinical Pharmacists’ Interventions on Patient Outcome. Case Reports in Psychiatry. 2020;2020:3419609.

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