Long-Acting Injectable (LAI) Antipsychotics are antipsychotics delivered via intramuscular injection that can provide medication coverage from a period of weeks to months. Once stabilized on an LAI, patients rarely will need oral antipsychotic supplementation.
Advantages of LAI include increased medication adherence compared to oral antipsychotics, and a reduced risk of re-hospitalization.[1][2]
Name | Initiation | Maintenance |
---|---|---|
Haloperidol decanoate | 50mg | 50 to 200mg, q3 to 4 weeks |
Fluphenazine decanoate | 12.5mg | 12.5 to 50mg, q2 to 3 weeks |
Flupenthixol decanoate | 20mg | 50 to 300mg, q2 to 4 weeks |
Zuclopenthixol decanoate | 100mg | 200 to 500mg, q1 to 4 weeks |
Name | Tradename | Formulations | Method of Delivery | Dosing Interval | Notes |
---|---|---|---|---|---|
Aripiprazole monohydrate | Abilify Maintenna | 300mg, 400mg | Vial, prefilled syringes | qmonthly | Requires a period of 2 weeks of oral dosing (“oral bridge”) with oral aripiprazole. Can be given via deep intramuscular (IM) deltoid or gluteal injection. |
Aripiprazole lauroxil | Aristada | 441mg, 662mg, 882 mg | Prefilled syringes | qmonthly (441–882 mg), or q6 weeks (882 mg) | The 882 mg dose can be administered every 6 weeks. Requires a period of 3 weeks of overlap with oral aripiprazole. Can be given via deep intramuscular (IM) deltoid or gluteal injection. |
Olanzapine pamoate | Zyprexa Relprevv | 210mg, 300mg, 405mg | Vial | 150 to 300 mg q2 weeks, or 300 to 405 mg qmonthly. | Requires monitoring post-injection (3 hours). For deep intramuscular gluteal injection only and not approved for deltoid injections. |
Paliperidone palmitate | Invega Sustenna, Xeplion | 39mg, 78mg, 117mg, 156mg, 234 mg | Prefilled syringes | qmonthly | Oral supplementation not necessary (as per drug monograph), though is still done in practice. Can be given via deep intramuscular (IM) deltoid or gluteal injection. |
Paliperidone palmitate | Invega Trinza | 273mg, 410mg, 546mg, 819 mg | Prefilled syringes | q3 months | Use in patients already treated with Invega Sustenna. Can be given via deep intramuscular (IM) deltoid or gluteal injection. |
Risperidone microspheres | Risperdal Consta | 12.5mg, 25mg, 37.5mg, 50 mg | Vial | q2 weeks | Requires a period of 3 weeks of overlap with oral risperidone. Can be given via deep intramuscular (IM) deltoid or gluteal injection. |
If an LAI is missed, the following schedule can be followed without restarting a titration: