Evidence-Based Reviews

Long-acting injectable antipsychotics: What to do about missed doses

Current Psychiatry. 2018 July;17(7):10-12,14-19,56

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Address barriers to adherence

When addressing missed LAIA doses, be sure to identify any barriers that may have led to a missed injection. These might include:

bothersome adverse effects
transportation difficulties
issues with insurance/medication coverage
comorbidities (ie, alcohol/substance use disorders)
cognitive and functional impairment caused by the patient’s illness
difficulty with keeping track of appointments.

Clinicians can work closely with patients and/or caregivers to address any barriers to ensure that patients receive their injections in a timely fashion.

The goal: Reducing relapse

LAIAs improve medication adherence. Although nonadherence is less frequent with LAIAs than with oral antipsychotics, when a LAIA dose is missed, it is important to properly follow a stepwise approach based on the unique properties of the specific LAIA prescribed. Proper management of LAIA missed doses can prevent relapse and reoccurrence of schizophrenia symptoms, thus possibly avoiding future hospitalizations.

Acknowledgments

The authors thank Brian Tschosik, JD, Mary Collen O’Rourke, MD, and Amanda Holloway, MD, for their assistance with this article.

Bottom Line

Although long-acting injectable antipsychotics (LAIAs) greatly assist with adherence, these agents are effective only when missed doses are avoided. When addressing missed LAIA doses, use a stepwise approach that takes into consideration the unique properties of the specific LAIA prescribed.

Related Resources

Haddad P, Lambert T, Lauriello J, eds. Antipsychotic long-acting injections. 2nd ed. Oxford, UK: Oxford University Press; 2016.
Diefenderfer LA. When should you consider combining 2 long-acting injectable antipsychotics? Current Psychiatry. 2017;16(10):42-46.

Drug Brand Names

Aripiprazole long-acting injection • Abilify Maintena
Aripiprazole lauroxil long-acting injection • Aristada
Fluphenazine decanoate • Prolixin decanoate
Haloperidol decanoate • Haldol decanoate
Olanzapine pamoate long-acting injection • Zyprexa Relprevv
Paliperidone palmitate monthly long-acting injection • Invega Sustenna
Paliperidone palmitate 3-month long-acting injection • Invega Trinza
Risperidone long-acting injection • Risperdal Consta

References

Antipsychotics linked to increased body fat, insulin resistance in children

Long-acting injectable antipsychotics: What to do about missed doses

References

Address barriers to adherence

The goal: Reducing relapse

Bottom Line

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