Antipsychotic formulations

Question 1

ODT

Answer 1

There is no absorption, it is just to inc adherance

► Risperdal M-tab
► Zyprexa Zydis

► Pharmacokinetics are unchanged

Question 2

sublingual

Answer 2

► Asenapine (Saphris) is the only sublingually absorbed antipsychotic

► Onset of action is 30-90 minutes

► Negligible absorption if swallowed
► No food or drinking for 10 minutes

► Black cherry flavor is recommended

► May be useful in patients with absorption issues or NPO

Question 3

short acting injectables: Rx and side effect profile

Answer 3

Chlorpromazine Sedating

Fluphenazine High risk EPS

Haloperidol High risk EPS

Olanzapine Sedating, lowest risk of QTc prolongation
Do not give within 1-2 hours of parenteral BZDs

Ziprasidone Less sedating

Question 4

Long Acting Injectables (8)

Answer 4

Haldol D
Prolixin D
Abilify Maintera
Aristada
Invega
Risperdal consta
Perseris
Zyprexa

Question 5

Haldol D

Answer 5

Dosing interval of 4 wks

Dosing strategy (multiple options)
i. Loading

Complicated technique listed
Strategy 2 preferred: PO then maintenance, then oral overlap then taper and d/c after 2-3 injections

Question 6

Proloxin D

Answer 6

PO overlap recc
So dec PO by half then d/c after 2nd inj

Dose interval 2-4 wks

Conversion technique noted

Question 7

Abilify Maintena

Answer 7

PO overlap needed for 14 days

Dosing interval 4 wks

400mg qmo

Adjust for 3A4 inhibitors/inducers and 2D6 inhibitors

Question 8

Aristada

Answer 8

Also aripiprazole

Dosing noted based on PO dose with multiple options

Cont oral 21 days

Note adjust with 3A4 and 2D6

Question 9

Invega Sustenna, Trinza, Hafyera

Answer 9

Check if tolerable with paliperidone or risperidone PO

Use loading dose

Deltoid IM only

Adjust for renal insuff
i. Not for CC of <50

Dosing interval 4 wks

Standard protocol for maint dose and based on PO

ALSO a 3 mo formulation
Need 1 mo formulation for 4 mo with last 2 months the same dose

Conversion needed

ALSO 6 mo
i. Start with next 3 mo
ii. Very costly

Question 10

Risperdal Consta

Answer 10

Not as common with Invega

Refrigerated

Q2 wks

Cont PO 3-6 wks

Question 11

Perseris

Answer 11

a. Subq
b. Qmo
c. No loading dose
d. Causes bubble of drug under the skin
Good to tell patient
e. Dose based on PO

Question 12

zyprexa relprevv

Answer 12

a. Loading dose
b. No PO overlaps
c. REMS program
Monitor 3 mo post injection r/t delirium sedation syndrome found in clinical trials
1. Basically will cause olanzapine overdose

Question 13

Inhaled

Answer 13

Adasuve
a. Staccato loxapine
b. Need advance airway available initially but now don’t need and more commonly seen
c. Fast acting 2-10 min

Question 14

ingestible event marker

Answer 14

Abilify mycite
a. Tablet with a IEM sensor inside

Tracks if it has been taken and tells smart phone

Not always accurate

Question 15

transdermal

Answer 15

1. Secuado
   a. Asenapine

Qd
Alternate site
3 strengths