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An update on recently approved long-acting injectable second-generation antipsychotics: Knowns and unknowns regarding
1Clinical Associate Professor, University of Michigan College of Pharmacy, Ann Arbor, Michigan, amberg@med.umich.edu.
The Mental Health Clinician
|November 21, 2022
Summary
Second-generation long-acting injectable antipsychotics improve adherence but have unknowns. This review addresses adherence, dosing, and pharmacogenomics using patient cases.
Area of Science:
- Pharmacology and Psychiatry
- Neuroscience
- Clinical Pharmacy
Background:
- Nine second-generation long-acting injectable antipsychotics (LAIA) are FDA-approved, including aripiprazole, olanzapine, paliperidone, and risperidone formulations.
- LAIAs are frequently prescribed to enhance medication adherence and improve patient outcomes in psychiatric care.
- Extensive research exists on LAIA population pharmacokinetics, CYP interactions, and clinical/economic outcomes over nearly two decades.
Purpose of the Study:
- To address persistent knowledge gaps concerning second-generation LAIAs.
- To explore critical clinical issues including medication adherence, transitioning from oral to injectable antipsychotics, renal dosing considerations, pharmacogenomic applications, and strategies for managing missed doses.
- To illustrate these issues through the practical application of four distinct patient case studies.
Main Methods:
- Review of existing literature on second-generation long-acting injectable antipsychotics.
- Analysis of population pharmacokinetics, drug interactions, and clinical outcomes.
- Case-based discussion of adherence, oral-to-injectable transitions, renal dosing, pharmacogenomics, and missed dose management.
Main Results:
- While LAIAs offer benefits in adherence and outcomes, specific challenges remain.
- Key areas requiring further attention include optimizing transitions, appropriate renal dosing, leveraging pharmacogenomics for personalized treatment, and developing clear protocols for missed doses.
- Patient case studies highlight the complexity and individualized nature of managing these aspects.
Conclusions:
- Second-generation LAIAs are valuable tools, but optimal utilization requires addressing specific clinical challenges.
- Further research and clinical guidelines are needed to refine strategies for adherence, dose adjustments (including renal), pharmacogenomic integration, and missed dose management.
- A case-based approach effectively demonstrates practical considerations for improving patient care with LAIAs.
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