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Long-Acting Injectable Antipsychotics in Adolescents: From Current Evidence and Gaps to Clinical Practice
Simone Pardossi1, Alessandro Cuomo1, Giacomo Gualtieri2
1Department of Molecular Medicine, University of Siena School of Medicine, 53100 Siena, Italy.
Pharmaceuticals (Basel, Switzerland)
|October 29, 2025
Summary
Long-acting injectable antipsychotics (LAIs) show promise for adolescents with severe psychiatric conditions, improving adherence and outcomes. However, limited data necessitates further research and careful clinical monitoring, especially with co-occurring substance use disorders.
Area of Science:
- Psychiatry
- Pharmacology
- Adolescent Health
Background:
- Adolescence is a critical period for severe psychiatric disorders like psychosis.
- Non-adherence to oral antipsychotics is prevalent in adolescents, leading to relapse and functional decline.
- Co-occurring substance use disorders (SUDs) exacerbate non-adherence and worsen clinical outcomes.
Purpose of the Study:
- To review the existing evidence on the efficacy and safety of long-acting injectable antipsychotics (LAIs) in adolescents.
- To outline potential clinical practice recommendations for LAI use in this population.
- To identify gaps in current research regarding LAIs for under-18 individuals.
Main Methods:
- A narrative review of scientific literature was performed.
- Evidence was systematically organized by antipsychotic drug class, including risperidone, paliperidone, and aripiprazole LAIs.
- Data on efficacy, safety, and clinical outcomes were synthesized.
Main Results:
- Evidence for LAI use in adolescents is limited and varied.
- Specific LAIs demonstrated benefits in symptom severity, functioning, and reduced hospitalizations for conditions like schizophrenia and bipolar disorder.
- Common side effects included EPS and hyperprolactinemia; off-label use is reported in selected cases.
Conclusions:
- Current data on LAIs in adolescents are sparse, with no established clinical guidelines.
- Off-label LAI use may be considered in specific adolescent cases with careful monitoring and psychosocial support.
- Urgent need for prospective, controlled studies to confirm long-term efficacy and safety in this population, especially with co-occurring SUDs.
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