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Ruling Out Hypersensitivity Before Starting a Long-Acting Injectable

December 09, 2019

In this occasional feature, members of the Psych Congress Steering Committee and faculty answer questions asked by attendees at Psych Congress meetings.

QUESTION: How long do you give oral medication to rule out hypersensitivity before starting a patient on a long-acting injectable antipsychotic?

ANSWER: One or two oral doses are usually sufficient to know if there is going to be an acute hypersensitivity reaction.

Clinical trials of long-acting injectable antipsychotics usually have the study drug-naive patient receive test doses, as in, for example, the study of aripiprazole lauroxil, where "Aripiprazole-naive patients were given a test dose of oral aripiprazole 5 mg administered daily for 2 days prior to randomization to assess tolerability. Patients who had previously taken and tolerated aripiprazole were not required to undergo the tolerability assessment."1

However, a more complete assessment of tolerability would take a longer period of time, and would depend on your clinical judgement and the individual patient's values and preferences.

Leslie Citrome, MD, MPH, Clinical Professor, Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York


Meltzer HY, Risinger R, Nasrallah HA, et al. A randomized, double-blind, placebo-controlled trial of aripiprazole lauroxil in acute exacerbation of schizophrenia. The Journal of Clinical Psychiatry. 2015;76(8):1085–1090.


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