Long-Acting Injectable Antipsychotics:
Who should receive LAIs?
Consider LAIs for patients with recent-onset schizophrenia and those with risk factors for medication nonadherence:
history of non-adherence, severe symptoms, comorbid substance use, cognitive impairment,
ambivalence or negative attitudes towards medications, and poor insight.
Are the newer LAIs more effective?
The effectiveness of newer LAIs (aripiprazole, olanzapine, paliperidone and risperidone) and older LAIs
(haloperidol,fluphenazine, flupenthixol) is similar.
Practical considerations
Abilify Mantenna
Aripiprazole monohydrate requires a period of overlap of 2 weeks with oral aripiprazole.
Available as a lyophilized powder which needs to be reconstituted.
Aristada
Aripiprazole lauroxil requires a period of overlap of 3 weeks with oral aripiprazole.
Available as a prefilled syringe that does not require reconstitution.
Zyprexa Relprevv
Olanzapine pamoate does not need overlap with oral olanzapine.
It has a small risk of post-injection syndrome (0.07% of injections):
o Symptoms include sedation, confusion, agitation, anxiety, aggressiveness, dizziness, ataxia and
extrapyramidal symptoms
o This risk limits use olanzapine pamoate use
o After injection, the patient must be monitored for three hours by a healthcare professional
o In the US, prescribers who administer Zyprexa Relprevv must enroll in a national registry that
documents the incidence of this adverse effect
Invega Sustenna
Paliperidone palmitate does not need overlap with oral paliperidone.
Requires two separate loading dose injections during the first week.
Invega Trinza
The 3-month paliperidone palmitate (PPM–3) formulation can only be used if the patient has been receiving 1-
month paliperidone palmitate injections for at least 4 months.
It is administered 4 times a year, providing the longest interval of any approved LAI.
Risperdal Consta
Risperidone microspheres requires a period of overlap of 3 weeks with oral risperidone.
It has a 2-week dosing interval.
