LAIs

Question 1

Consta

risperidone

Answer 1

Indication: Schizophrenia; Bipolar Manic or Mixed

Oral Overlap: 21d at usual dose

Initial Dosing: 25mg every two weeks

Dosing Interval: every two weeks

Maintenance Dose: <4mg/d = 25mg; 4-6mg/d = 37.5mg; >6mg = 50mg; adjust no more than every month

Injection Site: deltoid or gluteal

Pearls: needs to be refrigerated; painful injection; shake for ten (10) second

Question 2

Perseris

risperidone

Answer 2

Indication: Schizophrenia

Oral Overlap: None required

Dosing: 3mg dose = 90mg; MAX=120mg

Dosing Interval: Monthly

Injection Site: SQ in abdomen

Pearls: not a good option for those on high doses of risperidone; not as painful

Question 3

Invega Trinza
(paliperidone)

Answer 3

Indication: Schizophrenia (after four months on Invega Sustenna)

Oral Overlap: None required

Initial Dosing: 78mg Sustenna=273mg Trinza; 117mg Sustenna=410mg Trinza

Dosing Interval: every three (3) months

Injection Site: deltoid or gluteal

Pearls: vial to be shaken for >15s

Question 4

Invega Sustenna
(paliperidone)

Answer 4

Indication: Schizophrenia; Schizoaffective Disorder

Oral Overlap: None required

Initial Dosing: 234mg in deltoid, then 156mg one (1) week later (also deltoid), then 117mg one week later

Dosing Interval: q4 weeks

Maintenance Dose: 3mg/d = 39-78mg
6mg/d = 117mg
12mg/d = 234mg
Average effective dose = 120mg

Injection Site: deltoid or gluteal (initial two doses are only deltoid)

Pearls: less painful; initial dosing complicated

Question 5

Zyprexa Relprevv

olanzapine

Answer 5

Indication: Schizophrenia

Oral Overlap: None required

Initial Dosing: 10mg/d = 210mg q2 weeks x 4 or 405mg q4weeksx2
15mg/d = 300mg q2week x 4 doses
20mg/d = 300mg q2weeks

Dosing Interval: q 2 or q4 weeks

Maintenance Dose: 10mg/d = 150mg q2 weeks or 300mg q4 weeks
15mg/d = 210mg q 2weeks or 405mg q4weeks
20mg/d = 300mg q2weeks

Injection Site: gluteal

Pearls: can cause delirium post-injection (1%) – requires 3 hours post-injection monitoring; requires Eli Lilly registration

Question 6

Aristada Initio

aripiprazole

Answer 6

Indication: Schizophrenia

Oral Overlap: One (1) day at 30mg of aripiprazole

Initial Dosing: One time does of 675mg

Injection Site: gluteal

Question 7

Astridada

aripiprazole

Answer 7

Indication: Schizophrenia

Oral Overlap: 21d of usual dose (or dose of Initio)

Initial Dose: 10mg/d = 441mg
15mg/d = 662mg
20mg/d = 882mg

Dosing Interval: q4 weeks; q6 (at 15mg/d – 882); q2mos (at 15mg/d – 1064mg)

Maintenance Dose: As per maintenance dose.

Injection Site: smallest dose can be deltoid or gluteal; higher doses only gluteal

Question 8

Abilify Maintena
(aripiprazole)

Answer 8

Indication: Schizophrenia; Bipolar Disorder

Oral Overlap: 14d of usual dose

Initial Dosing: 400mg

Dosing Interval: q4 weeks

Maintenance Dose: 400mg (average effective is actually 463mg)

Injection Site: deltoid or gluteal

Question 9

Haldol Decanoate
(haloperidol)

Answer 9

Indication: Schizophrenia

Oral Overlap: a) Usual oral dose x 7d, then reduce to 50% for two weeks
b) None if 20x loading dose

Initial Dosing: a) 10-15x oral dose
b) 20x oral dose (if no oral overlap)
IF >100mg, then give 100mg, then remainder in 2 weeks

Dosing Interval: q4 weeks

Maintenance Dose: 10-15x oral dose

Injection Site: gluteal

Question 10

Prolixin Decanoate

fluphenazine

Answer 10

Indication: Schizophrenia

Oral Overlap: usual dose for 3d; decrease by 50% every 3d until next injection

Initial Dosing: 1.25x usual dose

Dosing Interval: q2 weeks

Maintenance Dose: As per initial dose; do not increase more than 12.5mg per dose; do not exceed 100mg/dose

Injection Site: gluteal

Pearls: painful