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Converting oral to long-acting injectable antipsychotics: a guide for the perplexed

Published online by Cambridge University Press:  19 January 2018

Jonathan M. Meyer
Jonathan M. Meyer*
Affiliation:
Psychopharmacology Resource Network, California Dept. of State Hospitals, Patton, California, USA Dept. of Psychiatry, University of California, San Diego, La Jolla, California, USA
*
*Address for correspondence: Jonathan M. Meyer, MD, UCSD Dept. of Psychiatry, 4225 Executive Square #1130, La Jolla, CA 92037. (Email: jmmeyer@ucsd.edu)
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Abstract

There has been increasing recognition that antipsychotic nonadherence is common across all stages of schizophrenia, starting from the first episode. Moreover, numerous meta-analyses of the existing literature indicate superiority of long-acting injectable (LAI) over oral antipsychotics when one adjusts for the greater illness severity and duration among patients in LAI antipsychotic trials. The increasing availability of LAI antipsychotic options has raised interest in converting patients from oral medication; however, the successful transition from oral to the comparable LAI antipsychotic requires an understanding of the current extent of antipsychotic exposure, the kinetics of the LAI preparation, and the expected plasma levels achieved by the LAI formulation. The purpose of this article is to provide, in a concise format, the essential information for converting patients to the LAI forms of haloperidol, fluphenazine, risperidone, paliperidone, olanzapine, and aripiprazole from the comparable oral medication, and how the use of plasma antipsychotic levels can be invaluable for this process.

Keywords

Antipsychoticdepotkineticslong-acting injectable

Information

Type
CME Review Article
Information
CNS Spectrums , Volume 22 , Supplement S1: CME SUPPLEMENT , December 2017 , pp. 14 - 28
Copyright
© Cambridge University Press 2018 

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Footnotes

This activity is supported by an unrestricted educational grant from Alkermes.

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