Psychiatric Pharmacy Essentials: Long-acting Injectable Antipsychotics

Long-acting injectable (LAI) antipsychotics are unique medication formulations used in psychiatric pharmacy to help improve patient outcomes. They offer several benefits compared to oral therapy, including confirmed patient adherence, consistent drug delivery, predictable bioavailability, and prevention of antipsychotic overdose. LAIs are commonly used with the notion that they will decrease relapse rates by improving medication adherence; however, the data is limited. The following questions address the safety and efficacy of LAIs.

  • What antipsychotics are available as long-acting injections (LAIs), how are they dosed, and do they require oral overlap?1-3
  • How do the LAIs compare to one another?4-9
  • How do the LAI formulations of antipsychotics compare to oral formulations regarding efficacy, adherence, and relapse prevention?10-18
  • What is the role of LAIs in first-episode/early schizophrenia?19-20
  • How do patients and providers feel about LAI use?21-27
  • Are patients ever on both LAIs and oral formulations?28
  • What are the limitations to using the olanzapine LAI?29-30
  • Many LAIs are expensive; where can I find cost-effectiveness data?31-32
  • What are the most common medication errors associated with LAIs and potential management strategies?33
  • Where can I receive training on how to use LAIs?34
  • How do I manage missed doses of common LAIs?35

Reviewer 1: Joseph M. Cusimano, PharmD, BCPP
Reviewer 2: Allison Beatty, PharmD, BCPP
Reviewer 3: Austin Smith, PharmD, BCPP
2023-2024 AAPP Resident and New Practitioner Committee

References

  1. Pocket Guide to LAIs. Distributed as part of the Long-Acting Injectable Antipsychotics; updated in 2019: Changing the Landscape of LAI Utilization symposium offered at the 2014 CPNP Annual Meeting. [Weblink]
    • Provides guidance on dosing parameters; supplying, storing, and handling; injection techniques; and considerations for success.
    • Available to those who attended 2014 CPNP Annual Meeting.
  2. Preskorn SH. Switching From the Oral to the Depot Formulation of a Medication: Clinically Relevant Pharmacokinetic Concepts and Considerations. J Psychiatric Pract. 2017;23(3):200-209. DOI: 10.1097/PRA.0000000000000236. PubMed PMID: 28492458.
  3. American Psychiatric Association. SMI Adviser. What should clinicians know about Invega Hafyera (paliperidone palmitate 6-month LAI)? Available at: [Weblink]
    • Provides details on Invega Hafyera, and additional information regarding each LAI is available through SMI Adviser at [Weblink]
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  33. Crouse EL. Long-acting injectable antipsychotics: what to do when things don’t go as planned. Presented at the CPNP Annual Meeting (2020). [Weblink]
    • Presentation reviews recommended administration and monitoring for LAIs, highlighting specific areas that may be more prone to medication errors. The presentation also addresses treatment plans and modifications in response to LAI-related medication errors.
  34. AAPP. Psychotropic Long-Acting Injectable (LAI) Training Program. [Weblink]
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