So which LAI do you prefer to prescribe?

[Blitz2006]

I've noticed during my outpatient residency experience, in our area, most Psychiatrists only go with Invega Sustenna....and rarely Hal Dec. I never see Risperdal Consta or Prolixin....and never Zyprexa Relprev/Abilify Maintenna.

Your thoughts?

I'm also surprised that I never see Trinza...shouldn't it have overtaken Sustenna, once every 3 months is > than monthly, no? Unless its still considered "too new"...but its been in the market for over 1.5 years now...

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[deleted736562]

It really depends on whatever works PO. There is definitely a lot of Haldol dec where I'm at. I also see quite a bit of Consta, Prolixin, and even Maintenna. I like Abilify honestly. Relprev isn't practical since patient need to be observed for a certain time period after each injection because of risk of delirium.

For Trinza, I believe patients should be maintained on Sustenna before transitioning to Trinza.

 

[Shikima]

Invega mostly.

 

[Jules A]

Invega mostly.

There are plenty of reasons to like Invega but anecdotally are you finding it holds the floridly psychotic patients adequately?

 

[PistolPete]

There are plenty of reasons to like Invega but anecdotally are you finding it holds the floridly psychotic patients adequately?

I've had good results with Invega.
Have seen Haldol dec and fluphenazine at the VA mostly. In the community, Sustenna and Consta. I've never used or seen Abilify Maintena. Curious to see Trinza soon.

 

[Blitz2006]

There are plenty of reasons to like Invega but anecdotally are you finding it holds the floridly psychotic patients adequately?

what are the reasons for liking Invega....then say...over Consta?

 

[st2205]

what are the reasons for liking Invega....then say...over Consta?

Dosing frequency. That said, insurance not covering it as much here and I don't have anyone on it.

 

[F0nzie]

what are the reasons for liking Invega....then say...over Consta?

Consta is q2 weeks and patients find it quite restrictive. There are advantages to more frequent visits but if noncompliance is a dominant factor-- the longer it lasts the better. Push the next hospital admission back a bit?

Trinza requires 4 consecutive Sustennas... if you can get the patient to attend 4 consecutive visits! Also you don't want to slam someone with 3 months worth of medication if they are not able to tolerate it. It works well although 20% of my patients experienced relapsing symptoms after week 10.

Regarding Haldol and Prolixin dec those are fine for patients who fail SGA injections and do better on them than on alternatives. After going through the trials some patients will be able to tell the difference.

Zyprexa has a postinjection delirium warning and patients need to be monitored in the clinic after administration. This is a massive time sink on staff resources. It might be good but I don't see many clinics offering this.

I think Abilify maintena is underrepresented. Aside from akithesia it has milder EPS and the metabolic profile is much less offensive.




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[Shikima]

There are plenty of reasons to like Invega but anecdotally are you finding it holds the floridly psychotic patients adequately?

Yes. And many have transitioned into the 3 month depot quite easily and happily. Many have regained function in life.

Those who are state asylum material likely will not benefit from it but would need Clozaril and Zyprexa combined.

 

[Jules A]

Dosing frequency. That said, insurance not covering it as much here and I don't have anyone on it.

In my area the pharm reps are giving Sustenna out to hospitals and OP practices in an effort to eventually transition the patient to Trinza.

 

[wannabie]

Almost only paliperidone where I'm at. They're trying to the three month version onto the formulary, and I expect to see a lot of it when it is. But I've also seen haloperidol and fluphenazine injectibles here. It's a shame that the olanzapine injectable had its difficulties. From I've read and learned, it seems that the observation was due to people accidentally injecting it into the veins. Is that a correct understanding of it? It's definitely not practical

 

[SourceOfDenial]

I prescribe the one where the rep buys the best lunch.

 

[HarryMTieboutMD]

Depends on the patient population, insurance, etc. One day a week I am at what is functionally a state funded CMHC (but I can't remember exactly what it falls under) where medication cost isn't an issue, and I have had some good results with Abilify Aristada. Truthfully I like Haldol D the best for patients who can tolerate it because of dosing flexibility, reliability of pharmacokinetics, etc. People like Invega Sustenna assuming it's not underdosed. The only reason I would prescribe Prolixin D or Risperdal consta is if someone were stable on it or or if the perfect storm of insurance/tolerability issues arose. Q2week injections with other options available... why?! Not even the private doctors with cash only patients use Zyprexa Relprevv bc of PDSS, which I guess has been a moot point in the post marketing data...

 

[JustAGuy]

For younger, newly psychotic patients, I often start them on Abilify and transition to Maintena. Invega is also very commonly used. Consta some but less so because of the q2wk frequency. I only have a couple people on older LAIs (haldol, fluphenazine) just because that's what they were stabilized on, and have seen these used sometimes in the VA, state hospital, and community mental health places. Have absolutely 0 experience with Zyprexa.

 

[st2205]

Not even the private doctors with cash only patients use Zyprexa Relprevv bc of PDSS, which I guess has been a moot point in the post marketing data...

How many people in your area requiring LAI are cash pay patients?

 

[HarryMTieboutMD]

How many people in your area requiring LAI are cash pay patients?

A decent amount, actually... they are mostly family members of well to do families who send their relatives to the boutique practices

 

[Merovinge]

We use a fair bit of Maintena, particularly with younger populations due to SE profile. It's very easy to use outside of the 2 week first dose oral window. Invega works quite well, although I have seen a few patients respond to it less favorably than Consta.

Never even heard of someone consider Zyprexa due to the SE. Haldol and Prolixin Dec are still great for folks who need it as well.