Psychiatric Pharmacy Essentials: Long-acting Injectable Antipsychotics

Long-acting injectable (LAI) antipsychotics are unique medication formulations used in psychiatric pharmacy to help improve patient outcomes. They offer several benefits compared to oral therapy, including confirmed patient adherence, consistent drug delivery, predictable bioavailability, and prevention of antipsychotic overdose. LAIs are commonly used with the notion that they will decrease relapse rates by improving medication adherence; however, the data is limited. The following questions address the safety and efficacy of LAIs.

  • What antipsychotics are available as long-acting injections (LAIs), how are they dosed, and do they require oral overlap?1-3
  • How do the LAIs compare to one another?4-9
  • How do the LAI formulations of antipsychotics compare to oral formulations regarding efficacy, adherence, and relapse prevention?10-18
  • What is the role of LAIs in first-episode/early schizophrenia?19-20
  • How do patients and providers feel about LAI use?21-27
  • Are patients ever on both LAIs and oral formulations?28
  • What are the limitations to using the olanzapine LAI?29-30
  • Many LAIs are expensive; where can I find cost-effectiveness data?31-32
  • What are the most common medication errors associated with LAIs and potential management strategies?33
  • Where can I receive training on how to use LAIs?34
  • How do I manage missed doses of common LAIs?35

Reviewer 1: Trisha McHugh, PharmD
Reviewer 1: Austin Smith, PharmD, BCPP
2024-2025 AAPP Resident and New Practitioner Committee

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  16. Kishimoto T, Hagi K, Kurokawa S, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre–post studies. Lancet Psychiatry. 2021 May;8(5):387-404. Elsevier BV; 2021 May. DOI: 10.1016/s2215-0366(21)00039-0.
  17. Buckley PF, Schooler NR, Goff DC, Kopelowicz A, Lauriello J, Manschreck TC, et al. Comparison of Injectable and Oral Antipsychotics in Relapse Rates in a Pragmatic 30-Month Schizophrenia Relapse Prevention Study. PS. 2016 Dec 1;67(12):1370-1372. American Psychiatric Association Publishing; 2016 Dec 1. DOI: 10.1176/appi.ps.201500466.
  18. Kirson NY, Weiden PJ, Yermakov S, Huang W, Samuelson T, Offord SJ, et al. Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia. J Clin Psychiatry. 2013 Jun 15;74(06):568-575. Physicians Postgraduate Press, Inc; 2013 Jun 15. DOI: 10.4088/jcp.12r08167.
  19. Lian L, Kim DD, Procyshyn RM, Fredrikson DH, Cázares D, Honer WG, et al. Efficacy of long‐acting injectable versus oral antipsychotic drugs in early psychosis: A systematic review and meta‐analysis. Early Intervention Psych. 2022 Jun;16(6):589-599. Wiley; 2022 Jun. DOI: 10.1111/eip.13202.
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  22. Patel M, Haddad P, Chaudhry I, McLoughlin S, David A. Psychiatrists’ use, knowledge and attitudes to first- and second-generation antipsychotic long-acting injections: comparisons over 5 years. J Psychopharmacol. 2010 Oct;24(10):1473-1482. SAGE Publications; 2010 Oct. DOI: 10.1177/0269881109104882.
  23. Patel M, de Zoysa N, Bernadt M, Bindman J, David A. Are depot antipsychotics more coercive than tablets?. J Psychopharmacol. 2010 Oct;24(10):1483-1489. SAGE Publications; 2010 Oct. DOI: 10.1177/0269881109103133.
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  29. Detke HC, McDonnell DP, Brunner E, Zhao F, Sorsaburu S, Stefaniak VJ, et al. Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, I: analysis of cases. BMC Psychiatry. 2010 Dec;10(1). Springer Science and Business Media LLC; 2010 Dec. DOI: 10.1186/1471-244x-10-43.
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