Risperdal Consta - Stuck?

[SpinDktr]

I have a 69 y/o m with schizophrenia who had been taking oral risperidone and doing well for over 10 years at 4mg/day. He went into a SNF, and thanks to GDR issues he was tapered off, and is now psychotic. He believes he has been healed and no longer needs any oral medications (he has HTN, DM, HLP, and needs anticoagulant due to stroke).

I would have preferred to start him on Sustenna, but b/c of his good response to risperidone, at an outside hospital he was started on Consta 25 mg on 7/15. Am I stuck with the Consta pathway, or is there a way to still get him on Sustenna safely?

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[ObsequiousAplomb]

Sure, you can easily switch him over to Sustenna. Just give Sustenna at the next scheduled Consta injection. 25 mg Consta = 78 mg Sustenna.

But since he was started on Consta 7/15 and today is 7/21, I would just start the Sustenna immediately. The Consta hasn't even started releasing the Risperdal yet. It wouldn't be at steady state for ~6 more weeks, if he were to continue with injections every 14 days. If he's only had one injection of Consta, I would essentially ignore its presence, especially if you're not giving him any PO Risperdal since he's refusing it.

 

[SpinDktr]

Huh, I guess I hadn't thought of it that way. I'll have to look into it a bit. I just thought it would mess with the front loading doses that are usually given with sustenna.

 

[wolfvgang22]

You can also move to Trinza later.

 

[ObsequiousAplomb]

Huh, I guess I hadn't thought of it that way. I'll have to look into it a bit. I just thought it would mess with the front loading doses that are usually given with sustenna.

Just think of it as a few days (in roughly a week or two) of guaranteed 2 mg/day of PO Risperdal. Since he's not taking any POs, it's essentially like doing an Invega load for someone who only accepts some of the PO a few of the days after the injections start.