experience using zyprexa relprevv?

[jamesearlejones]

hi all,

does anybody have experience using zyprexa relprevv? i've been working with some patients lately who have failed multiple trials of the other depot antipsychotics, including very high doses of consta. i've never used relprevv, nor do i know anybody who has. i understand that patients have to be monitored for several hours after getting the injection because it can lead to coma or ms changes, which sounds scary. anybody have experience with relprevv? what's your take on it?

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[nitemagi]

hi all,

does anybody have experience using zyprexa relprevv? i've been working with some patients lately who have failed multiple trials of the other depot antipsychotics, including very high doses of consta. i've never used relprevv, nor do i know anybody who has. i understand that patients have to be monitored for several hours after getting the injection because it can lead to coma or ms changes, which sounds scary. anybody have experience with relprevv? what's your take on it?

As you said, a lot of sedation that hopefully goes away. Used it twice, with individuals who responded well to oral zyprexa, have poor compliance, and didn't do well on other depots. It's a pain in the ass logistically (observation, etc)

 

[whopper]

I've only seen one appropriate use of it ever-at least my opinion. I saw a patient on the long-term unit that refused meds, court-ordered meds were obtained, but she kept fighting anytime meds were administered.

In reality, when court-ordered meds are approved, what usually happens is the patient acquiesces or does so after getting injected multiple times and wants to avoid the injection.

This one, well she kept fighting, every single day, every single administration. There was no way we were going to be able to administer an oral med to her. The only way she would take a med was by injection-and at that time nothing else had worked that was injectable.

The problem with Relprevv is the coma, and it's one that can happen even if the patient's been on it before with no prior problems. I see no reason to have to give this med unless nothing else worked besides Zyprexa, and the patient had a long history of noncompliance and dangerousness while off of it. (edit: or the patient, despite court-ordered meds, will not take anything oral, and even then Relprevv should be on the bottom list of injectable meds).

Then comes the next problem. Relprevv at max dosages is the equivalent of 20 mg a day of Zyprexa. Most patients I know where nothing else worked, that are noncompliant, usually need more than Zyprexa 20 mg a day.

 

[bashir]

Bump. Anybody have any experience with Relprevv? I have never seen it used but I think of it theoretically as a treatment strategy that could work for patients who have failed everything else and thus might be worth the hassle and risk, similar to clozapine. Am I missing something? I am thinking of a patient who is symptom free now with oral zyprexa, but after previous relapses, in which incomplete adherence was a likely factor, became treatment resistant to the antipsychotic she had been taking. It seems like a situation worth the risk as the stakes are high, even though she has good insight and attempts to be adherent. Probably a moot point because I don't know of any treatment facility that is set up to offer it locally. Just wondering if my logic here is sound, I guess.

 

[wannabie]

I don't have any experience using it, but my understanding of relprevv is that the post-injection syndrome which necessitates supervision occurs due to the depot being injected into a vein instead of muscle and that this type of reaction is a theoretical risk with other long acting injectables. The incidence rate appears to be about 0.07% per injection. There are cases of post-injection syndrome with other long acting injectables. However, due to the cluster of post-injection syndrome reactions when relprevv hit the market, people freaked out and now there's a ton of monitoring that makes it a hassle to prescribe.

My concerns about using it is that the monitoring required now is too arduous and insurances in my area don't cover it.

I think if your facility can handle the post-injection monitoring, you should do it. Although to be fair, I'm not sure if "adherence was a likely factor" that your patient is in fact "treatment resistant".

 

[DisorderedDoc417]

"You may slip into a coma and die" never seems to go over well while discussing benefits, risks, and adverse side- effects.

 

[Blitz2006]

I don't have any experience using it, but my understanding of relprevv is that the post-injection syndrome which necessitates supervision occurs due to the depot being injected into a vein instead of muscle and that this type of reaction is a theoretical risk with other long acting injectables. The incidence rate appears to be about 0.07% per injection. There are cases of post-injection syndrome with other long acting injectables. However, due to the cluster of post-injection syndrome reactions when relprevv hit the market, people freaked out and now there's a ton of monitoring that makes it a hassle to prescribe.

My concerns about using it is that the monitoring required now is too arduous and insurances in my area don't cover it.

I think if your facility can handle the post-injection monitoring, you should do it. Although to be fair, I'm not sure if "adherence was a likely factor" that your patient is in fact "treatment resistant".

"The incidence rate appears to be about 0.07% per injection. "

Interesting stat. Didn't realize the risk was this low... This is basically as low as getting agranulocytosis on clozaril...

 

[PistolPete]

"The incidence rate appears to be about 0.07% per injection. "

Interesting stat. Didn't realize the risk was this low... This is basically as low as getting agranulocytosis on clozaril...

Me neither. But because it has gotten such a bad rep, I've never used it or seen it used. I prefer any of the other LAI's.

 

[bashir]

I think if your facility can handle the post-injection monitoring, you should do it. Although to be fair, I'm not sure if "adherence was a likely factor" that your patient is in fact "treatment resistant".

To clarify, incomplete adherence was likely a factor in relapse, but after relapse the antipsychotic she had previously been stabilized on no longer worked even with complete adherence assured by hospitalization, even at higher doses. After a couple of times through this pattern I think it's fair to call the patient treatment resistant and acknowledge the risk that the next psychotic episode may be the one she never fully recovers from.

Naturally any other LAI is easier to use, but is any as effective? My understanding is that zyprexa is more effective than any antipsychotic except clozaril, and it seems worth thinking about how real the risk of post-injection syndrome is and whether that risk or the mandated monitoring procedures really warrant throwing this medication out the window. Lately I'm reading so much about the push to increase use of clozaril (which obviously comes with serious risks that require close monitoring), why no love for relprevv?

 

[Blitz2006]

To clarify, incomplete adherence was likely a factor in relapse, but after relapse the antipsychotic she had previously been stabilized on no longer worked even with complete adherence assured by hospitalization, even at higher doses. After a couple of times through this pattern I think it's fair to call the patient treatment resistant and acknowledge the risk that the next psychotic episode may be the one she never fully recovers from.

Naturally any other LAI is easier to use, but is any as effective? My understanding is that zyprexa is more effective than any antipsychotic except clozaril, and it seems worth thinking about how real the risk of post-injection syndrome is and whether that risk or the mandated monitoring procedures really warrant throwing this medication out the window. Lately I'm reading so much about the push to increase use of clozaril (which obviously comes with serious risks that require close monitoring), why no love for relprevv?

"My understanding is that zyprexa is more effective than any antipsychotic except clozaril", any links to back this up?

We basically only use Invega Sustenna here...and otherwise Hal Dec. I occasionally see Prolixin. I never see Abilify Maintena, Zyprexa Relprev or Risperdal Consta.

My understanding is that they are all the same in efficacy, LAIs (except for abilify)

Is this true?

I mean if Relprev is the best, and there is only 0.07% chance of post-injection coma.....