Long Acting Injectables

[Bad Moose]

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Hey Fellow Psychiatrists on SDN,

What is your favorite LAI?

I like Invega personally, but I am not sure whether to just take patients word on Risperdal or start a week trial on PO invega. Sometimes I get nervous starting a LAI even when the patient is agreeable to it. Just wondering if anyone else shares this experience.

 

[NickNaylor]

We probably use paliperidone the most since there is a nice benefit program from the manufacturer which makes it fairly affordable. Our outpatient clinic also seems to use a lot of haloperidol and risperidone. I don’t know if any patients that have used the aripiprazole or olanzapine LAIs.

I can’t say that I have a strong preference one way or another. I don’t have any outpatients on LAIs at the moment, and my experience with them has been limited to starting them on an inpatient unit.

 

[clausewitz2]

I have seen people do very well on LAI FGAs, haldol and fluphenazine both. Obviously less metabolically catastrophic than SGAs, which is important because people who end up on LAIs for a long time generally also need large doses. Unfortunately fluphenazine dec is not going to be manufactured any more after this year, so we are about to have a crop of long-termers who have been stable for years who we get to play neuroleptic-transition-roulette with.

 

[DisorderedDoc417]

Invega also has the trinza formulation which is awesome for compliance (4x yearly). There is a reason people don't use the LAI olanzapine.... Probably will never catch traction with its pesky risk.

 

[PistolPete]

I have seen people do very well on LAI FGAs, haldol and fluphenazine both. Obviously less metabolically catastrophic than SGAs, which is important because people who end up on LAIs for a long time generally also need large doses. Unfortunately fluphenazine dec is not going to be manufactured any more after this year, so we are about to have a crop of long-termers who have been stable for years who we get to play neuroleptic-transition-roulette with.

They’re stopping production of fluphenazine dec??!! That sucks!!

I use a lot of Haldol dec, fluphenazine and Invega Sustenna. In my anectodal experience, all have equal effectiveness, with Sustenna cost being by far the most. I find that in my state hospital patients, though, Sustenna doesn’t work as well, since for many patients the max dose of 234mg IM is equivalent to about only 4mg oral when getting a blood level, and that’s often not enough at controlling psychosis.