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Tips for Starting Patients on Long-Acting Injectables

July 10, 2018
Ilan Melnick, MD

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

QUESTION: How soon after first-episode psychosis is it appropriate to start a long-acting injectable (LAI), given that some will not recur?

ANSWER: The data have shown that after the second episode of psychosis, more likely than not, this will be a repeating condition (given that it is not induced by an external stressor, i.e. drugs). In our clinic, we recommend that we try to start an LAI as soon as the second episode, as the data have shown that the earlier you start an LAI, the better the chance of a favorable outcome.

QUESTION: Do you typically start patients on oral formulations to ensure tolerability?

ANSWER: Yes, I do. I will usually give a trial dose of a small amount of the medication to see if there is an anaphylactic reaction (usually a low dose for about 5 days) before giving an LAI.

QUESTION: When is oral supplementation in patients on LAIs warranted?

ANSWER: When an LAI has a long half-life, or has a mechanism of release which is slow.

For example:

Risperidone LAI: 21 days risperidone;

Olanzapine LAI: none needed;

Paliperidone LAI: none needed with a loading dose;

Aripiprazole Monohydrate LAI: 14 days of any antipsychotic;

Aripiprazole Lauroxil LAI: 21 days Aripiprazole.

—Ilan Melnick, MD, staff psychiatrist and chief medical officer, Passageway Residences of Dade County, Miami, Florida


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