LAI

[sujalneuro]

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Hello all,

Is it advisable to use LAI Haldol, Abilify etc in 70 plus years old patients with dementia and h/o schizophrenia with poor compliance. Its not FDA approved?

Thanks for your input in advance!!

 

[futuredo32]

I so wouldn't personally especially with the black box warning. If things go wrong it will take a long time for the LAI to leave their system. Any reason you are considering a LAI for this patient? Are they living with someone who could give pills- even mix them in with food? I took care of my Grandma who had dementia and mixed a lot of her meds in a home made juice. If they are in a nursing home they usually get their meds. I'm sure others will chime in with better advice. Tough call. Haldol and injectibles are not first line for dementia.

 

[whopper]

Not something I'd do first-line but hardly enough information was given in the post about the pt.

In general I'd avoid typical antipsychotics due to the neurodegeneration associated with them, but that's a very broad-stroke and sometimes you have to use the 4th, 5th, even lower down the road choices cause little else is working.

You also NEVER EVER EVER start a LAI without trying the oral form first. Why? Cause if the patient cannot tolerate the medication you just effed them up for a month. Good going Dr. Malpractice! (Not you but other doctors I've seen who've done this).

 

[sujalneuro]

Patient is doing well on Abilify has schizophrenia and has also dementia. She has no insight into her illness. She is taking Abilify in the hospital but once discharged has no desire to continue with follow ups or medications. I was wondering if I could try Abilify maintena? she doesn't have much family support and I saw her in ER. She is in ER for a week now as no inpatient is accepting patient due to prior failure with treatment and insurance issues. So, she is stuck in ER but her psychosis seems to have resolved.

 

[clausewitz2]

Patient is doing well on Abilify has schizophrenia and has also dementia. She has no insight into her illness. She is taking Abilify in the hospital but once discharged has no desire to continue with follow ups or medications. I was wondering if I could try Abilify maintena? she doesn't have much family support and I saw her in ER. She is in ER for a week now as no inpatient is accepting patient due to prior failure with treatment and insurance issues. So, she is stuck in ER but her psychosis seems to have resolved.

LAIs are not actually that great at increasing long term adherence; best days suggests that three months post discharge the difference between LAI and orals is nil. Turns out if you are motivated to skip taking pills you can also skip injection appointments. If she has no family support and doesn't want meds despite resolution of acute psychosis, how exactly are you going to get her to submit to taking shots long-term?

 

[sujalneuro]

LAIs are not actually that great at increasing long term adherence; best days suggests that three months post discharge the difference between LAI and orals is nil. Turns out if you are motivated to skip taking pills you can also skip injection appointments. If she has no family support and doesn't want meds despite resolution of acute psychosis, how exactly are you going to get her to submit to taking shots long-term?

That's true, makes sense. I don't know what to really do further to help this patient. She is in ER all stable. Maybe just discharge and try to get family involved, which really seems impossible. Thanks for your input.

 

[Merovinge]

LAIs are not actually that great at increasing long term adherence; best days suggests that three months post discharge the difference between LAI and orals is nil. Turns out if you are motivated to skip taking pills you can also skip injection appointments. If she has no family support and doesn't want meds despite resolution of acute psychosis, how exactly are you going to get her to submit to taking shots long-term?

This may be true for the average adult with no social support and a long history of schizophrenia (including for this patient who needs a legal guardian and a dementia appropriate living situation). However, patients that have some family support where getting into clinic once a month is feasible but fighting over a pill daily is not, or teenagers/young adults who have strong family support but struggle with insight/compliance can be big winners from LAIs. I had patients who had never taken 2 weeks worth of medication consecutively on LAIs for >12 months. LAIs are also nice in that the proof is in the pudding for your n=1 patient in front of you; either they come and get it and you know it or they do not and you tried but failed.