Converting oral to long-acting injectable antipsychotics: a guide for the perplexed

Area of Science:

• Psychiatry
• Pharmacology

Background:

• Antipsychotic nonadherence is prevalent in schizophrenia across all illness stages.
• Long-acting injectable (LAI) antipsychotics demonstrate superiority over oral formulations, even after adjusting for illness severity.

Purpose of the Study:

• To provide essential information for converting patients from oral antipsychotics to comparable LAI formulations.
• To guide clinicians on utilizing plasma antipsychotic levels during medication transitions.

Main Methods:

• Review of existing literature on LAI antipsychotics and oral to LAI conversion strategies.
• Analysis of pharmacokinetic data for commonly prescribed LAI antipsychotics.
• Guidance on interpreting plasma antipsychotic levels for successful transitions.

Main Results:

• Successful conversion requires understanding current antipsychotic exposure and LAI pharmacokinetics.
• Plasma antipsychotic levels are invaluable for guiding oral to LAI transitions.
• Specific conversion guidance is provided for haloperidol, fluphenazine, risperidone, paliperidone, olanzapine, and aripiprazole LAI formulations.

Conclusions:

• Optimizing schizophrenia treatment through LAI antipsychotic conversion is feasible and beneficial.
• Clinician understanding of LAI pharmacokinetics and plasma level monitoring is crucial for successful patient transitions.
• This guide offers practical information to facilitate effective oral to LAI antipsychotic conversions.