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What you need to know about medication adherence...

Antipsychotics are used in the management of schizophrenia and other psychiatric disorders. Several major trials have been conducted examining the treatment of schizophrenia, including examining effectiveness, side effect profile, and pharmacoeconomic differences. These major trials help guide the way that antipsychotics are utilized.

Antipsychotic dose equivalents may be utilized when switching between antipsychotics or when comparing different medications. Multiple methods are used to calculate antipsychotic dose equivalences, each with their own strengths and limitations. Variation in receptor binding profiles of newer agents, changes to methodology in clinical trials over the decades, and lack of dose response data for older agents means no one method will apply to all available agents.

Rating scores are often used in mental health and neurology to give objective values when assessing symptoms or changes in cognitive function. Additionally, some rating scores are utilized to assess the severity of medication side effects or risks associated with these agents.

The QT interval is defined as the amount of time for the ventricles of the heart to repolarize after activation. This number can vary based on an individual’s heart rate and is often corrected to the QTc interval. A prolonged QTc interval is a risk factor for developing torsades de pointes (TdP). Although TdP is a relatively rare event, it is a potentially life-threatening polymorphic ventricular tachycardia that can have severe consequences.

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.

Clozapine is a second-generation antipsychotic often reserved for use in treatment-resistant schizophrenia. Clozapine is associated with severe neutropenia (previously called agranulocytosis), which requires stringent laboratory monitoring and reporting to an online Risk Evaluation and Mitigation Strategy (REMS) website. Despite its unique effectiveness, compliance to laboratory monitoring requirements and its substantial adverse effect profile may limit clozapine usage.