1Why use LAIs?
Reduced administration frequency compared to oral antipsychotics may improve adherence and reduce hospital readmission rates by 30%
2Fluphenazine decanoate brand name
Prolixin Decanoate
3Prolixin Decanoate generic name
Fluphenazine decanoate
4Haloperidol decanoate brand name
Haldol Decanoate
5Haldol Decanoate generic name
Haloperidol decanoate
6Aripiprazole lauroxil brand name
Aristada
Aristada Initio
7Aristada
Aristada Initio generic name
Aripiprazole lauroxil
8Aripiprazole monohydrate brand name
Abilify Maintena
9Abilify Maintena generic name
Aripiprazole monohydrate
10Olanzapine pamoate brand name
Zyprexa Relprevv
11Zyprexa Relprevv generic name
Olanzapine pamoate
12Paliperidone palmitate brand name
Invega Sustenna
Invega Trinza
Invega Hafyera
13Invega Sustenna
Invega Trinza
Invega Hafyera generic name
Paliperidone palmitate
14Risperidone brand name
Risperdal Consta (IM)
Perseris (SQ)
15Risperdal Consta (IM)
Perseris (SQ) generic name
Risperidone
16Fluphenazine oral overlap?
Yes, with goal to discontinue oral within 1-2 months
17Haloperidol oral overlap?
Yes, with goal to discontinue oral within 1 month
18Aripiprazole oral overlap?
Abilify Maintena: Continue oral medication for 14 days
Aristada: Continue oral medication for 21 days unless patient also receives Aristada Initio
19Olanzapine oral overlap?
Not required
20Paliperidone oral overlap?
Not required
21Risperidone oral overlap?
Risperdal Consta: Continue oral medication for 3 weeks
Perseris: Not required
22Fluphenazine initial dose
1.25 x daily oral dose (or use conversion schedule)
23Fluphenazine target dose
6.25-50 mg (Max 100 mg)
24Fluphenazine dosing interval
Q 2 weeks
25Fluphenazine loading dose
N/A
26Haloperidol initial dose
10-20 x daily oral dose
1st injection max 100 mg, If initial dose >100 mg administer as 2 injections, 100 mg on day 1 then the remainder any day from day 4-8
27Haloperidol target dose
10-15 x daily oral dose (May administer >100 mg per injection, max 450 mg)
28Haloperidol dosing interval
Q 4 weeks
29Haloperidol loading dose
Yes
30Aripiprazole intitial dose
Abilify Maintena: 400 mg
31Aripiprazole target dose
400 mg (Max 400 mg)
32Aripiprazole dosing interval
Q month
33Aripiprazole loading dose
N/A
34Aripiprazole lauroxil initial dose
Aristada: 441, 662, 882, 1064 mg
Aristada Initio: 675 mg on day 1
35Aripiprazole lauroxil target dose
same as intitial
36Aripiprazole lauroxil dosing interval
Q 4, 6, or 8 weeks
37Aripiprazole lauroxil loading dose
No and no oral overlap if receive Initio
38Olanzapine pamoate initial dose
150-300 mg q 2 weeks
405 mg IM q 4 weeks
39Olanzapine pamoate target dose
same as initial
40Olanzapine pamoate dosing interval
Q 2 or Q 4 weeks
41Olanzapine pamoate loading dose
Yes no oral overlap required
42Invega Sustenna initial dose
234 mg IM day 1 + 156 mg day 8
43Invega Sustenna target dose
117 mg (Max 234 mg)
44Invega Sustenna dosing interval
Q 4 weeks
45Invega Sustenna loading dose
Yes and no oral overlap required
46Invega Trinza initial dose
273, 410, 546, 810 mg (based on Sustenna dose)
47Invega Trinza target dose
same as initial
48Invega Trinza dosing interval
Q 3 months
49Invega Trinza loading dose
Must start with Invega Sustenna
50Invega Hafyera starting dose
1092 mg or 1560 mg (based on Sustenna or Trinza dose)
51Invega Hafyera target dose
same as initial
52Invega Hafyera dosing interval
Q 6 months
53Invega Hafyera loading dose
Must start with Invega Sustenna
54Risperdal Consta initial dose
25 mg IM
55Risperdal Consta target dose
25-50 mg (Max 50 mg)
56Risperdal Consta dosing interval
Q 2 weeks
57Risperdal Consta loading dose
no
58Perseris initial dose
90 or 120 mg SQ
59Perseris target dose
same as initial
60Perseris dosing interval
Monthly
61Perseris loading dose
No and no oral overlap
62What is Aristada Initio?
One-time injection of aripiprazole lauroxil administered on day 1 of treatment in conjunction with first dose of Aristada
Achieve therapeutic level more quickly
Eliminates need for oral overlap following initiation of Aristada
63Oral Risperidone Dose 1mg/day
Monthly Invega Sustenna Dose 39mg IM
64Monthly Invega Sustenna Dose 39mg IM
Oral Risperidone Dose 1mg/day
65Oral Risperidone Dose 2mg/day
Monthly Invega Sustenna Dose 78mg IM
66Monthly Invega Sustenna Dose 78mg IM
Oral Risperidone Dose 2mg/day
67Oral Risperidone Dose 3mg/day
Monthly Invega Sustenna Dose 117mg IM
68Monthly Invega Sustenna Dose 117mg IM
Oral Risperidone Dose 3mg/day
69Oral Risperidone Dose 4mg/day
Monthly Invega Sustenna Dose 156mg IM
70Monthly Invega Sustenna Dose 156mg IM
Oral Risperidone Dose 4mg/day
71Oral Risperidone Dose 6mg/day
Monthly Invega Sustenna Dose 234mg IM
72Which LAI requires refrigeration
Risperidone SQ: perseris
73LAI vs Oral side effects
theoretically LAIs should have less side effects due to more stable concentrations, but meta analyses show similar side effects. Less hyperprolactinemia with LAI risperidone.
74What LAI has the worst injection site side effects?
Palperidone palmitate, up to 12% occurence of side effects
75LAI costs
generally more expensive than oral antipsychotics, aristada is not on the CT medicaid formulary, it is useful for avoiding oral overlap due to aristada initio.