What should providers consider when talking to patients and their families about starting a long-acting injectable (LAI) antipsychotic?

LAIs are NOT only an option of last resort! Offer LAIs earlier in the course of treatment, emphasizing their benefits such as prevention of relapse, improved outcomes, and patient and provider satisfaction.

Benefits of LAIs include:

• LAIs have been shown to improve survival. Treatment reduces the burdensome nature of psychotic symptoms, thus enabling engagement in health behaviors and a recovery oriented, meaningful life.
  • It is not possible to achieve optimal health without stabilizing mental health.
  • You want to emphasize that untreated psychiatric illness leads to:
    • 1) premature psychiatric death (e.g., suicide, accidents); and
    • 2) premature medical death, as only stable patients can address disease prevention or follow-through on medical treatment.
• LAIs reduce the risk of relapse due to unintentional or intentional non-adherence, as well as that of partial adherence.
• LAIs reduce the risk of unintentional or intentional overdose on oral antipsychotics.
• Receiving an injection monthly (or every two to twelve weeks) can be less intrusive or distressing than taking pills on a daily basis.
• Once a patient is stabilized on a LAI, family and social support relationships often can focus on aspects of recovery beyond negotiations about taking medication.
• LAIs provide steadier, more even levels of the antipsychotic medication in the bloodstream. The injectable formulation bypasses the first-pass metabolism of the liver, so more medication is available in circulation. As a result, at times the LAI dose-equivalent may be lower than the dose that the patient would take orally.
• Use of LAIs will also establish regular contact between the patient and healthcare team, which can be a tremendous support for patients in recovery.

The side effect profile of a LAI is expected to be similar to that of the oral formulation, which has been demonstrated to be effective and tolerated prior to initiation of LAI.

• We should acknowledge that PO meds do not have the injection site reactions (e.g., pain, induration).

Emphasize the importance of taking oral supplementation (e.g., with aripiprazole LAI [Abilify Maintena]) or returning to clinic for a loading dose (e.g., with paliperidone palmitate [Invega Sustenna]) as indicated to most quickly achieve therapeutic drug levels.

Clinicians may need to exam their own biases against utilization of LAIs. For more information about LAIs and their critical appraisal, see this article.