Multiple Long-Acting Injectable Antipsychotics for Treatment-Resistant Schizophrenia

Caton, Michael; Newman, William J.

doi:10.1097/jcp.0000000000000505

Cited by 7 publications

(22 citation statements)

References 9 publications

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“…In this case, it is possible to consider the combination of two LAI antipsychotics (13). In the literature, only a few case reports can be found detailing the use of combined application of typical and atypical LAI antipsychotics (14)(15)(16). In all cases, significant improvement and no adverse effects were reported.…”

Section: Discussionmentioning

confidence: 99%

Schizophrenia treatment with a combination of two LAI antipsychotics: A case report

Jarosz

Badura-Brzoza

2022

Front. Psychiatry

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Preventing the relapse of a psychotic episode is a challenge for the treatment of schizophrenia. Patients with schizophrenia suffer from a few to a dozen relapses in their lifetime. The use of long-acting injectable (LAI) antipsychotics in the treatment of schizophrenia is associated with less frequent recurrences of psychotic symptoms, better compliance, and better quality of life. The aim of the report is to present the findings of the successful management of treatment-resistant schizophrenia in a patient with persistent non-compliance using a combination of typical and atypical LAI antipsychotics. Since there was a history of non-adherence (irregular controls in outpatient clinics) by the patient, clozapine was not considered a therapeutic option. At the start of the treatment, olanzapine LAI was administered to the patient at a dosage of 300 mg fortnightly because of the good response and tolerance reported in the previous treatment. The treatment was continued for several weeks, and because of the persistence of constant delusions, labile affect, and aggressive behavioral tendencies, a second antipsychotic, zuclopenthyxole, was added, which was initially administered orally. After 4 weeks of combined treatment, the patient's mental state improved. There was no report of delusions, and his mood was much more stable. Zuclopenthyxole was switched to the LAI antipsychotic form due to the patient's history of persistent non-compliance, lack of insight into the disease, and the risk of aggressiveness toward others. Then, 200 mg of zuclopenthyxole decanoate was administered fortnightly. The patient was discharged from the hospital without any symptoms of delusions or hallucinations. The patient's clinical state presented negative symptoms, of which avolition and diminished social activity were dominant. The patient tolerated the treatment well, and sedation and extrapyramidal symptoms were not observed. The patient continued the injections alternately (one injection per week) to obtain regular visits to the outpatient clinic.

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Section: Discussionmentioning

confidence: 99%

Schizophrenia treatment with a combination of two LAI antipsychotics: A case report

Jarosz

Badura-Brzoza

2022

Front. Psychiatry

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“…When combining certain LAI with existing LAI with or without existing oral AP, clinicians should be more careful since there are a dearth of data regarding the mixed use of two or more LAIs. However some case series reports proposed the clinical utility of diverse combination of two different LAIs without further AEs including PP [ 86 - 88 ], RLAI [ 88 , 89 ], OP [ 86 , 88 , 90 ], and HD [ 90 ] in clinical practice. Even in one case report, it was used for adolescent patients with severe psychosis and aggression where clozapine was not a viable therapeutic option and the results endorsed the effectiveness of two LAIs combination without showing any tolerability issues [ 88 ].…”

Section: Discussionmentioning

confidence: 99%

Consideration of Long-Acting Injectable Antipsychotics for Polypharmacy Regimen in the Treatment of Schizophrenia: Put It on the Table or Not?

Pae

Han

Bahk

et al. 2021

Clin Psychopharmacol Neurosci

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Antipsychotic monotherapy (APM) is considered best-acceptable treatment option regardless of antipsychotic class and formulation types for treating schizophrenia. However, antipsychotic polypharmacy (APP) has been also widely utilized in routine clinical practice. Despite APP has some clinical benefits it has also numerous pitfalls in relation with increased total number and doses of APs leading to adverse events as well as decrease of treatment adherence and persistence resulting in poor clinical outcomes. Recent introduction of long-acting injectable antipsychotics (LAIs) to the market has offered a chance for better medication adherence/persistence and also provided a simplification of treatment regime leading to more stabilized treatment for schizophrenia patients. When we cannot stay away from APP in the treatment of schizophrenia, clinicians need to find more proper APP regimens and thereby utilization of APP in efficient way should be a practical strategy to benefit schizophrenia patient in a real world treatment setting. With this regard, LAIs can be one of available APP regimen for treatment of schizophrenia in routine practice since their clinical utility and pharmacokinetic stability over oral APs have been well-elaborated today. However, when we have to commence LAIs as a part of APP with oral APs or other LAIs, every effort should be made before doing so whether or not validated and available treatment options or other clinical factors were not done or evaluated yet. Any treatment guidelines do not support APP regardless of the formulation of APP regimen or address two or more LAIs for treatment of schizophrenia till today.

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“…First, dual LAI therapy is only utilized in challenging cases 9 - 14 in which the use of oral antipsychotic medications has not been successful. Second, a majority of the authors 9 , 10 , 12 , 13 recommend close monitoring given the rarity of this treatment plan. Last, clinicians should consider concurrent LAI medications with varied receptor activity.…”

Section: Discussionmentioning

confidence: 99%

“…There was a total of 9 dual LAI case reports [9][10][11][12][13][14] as shown in the Table . Although there were no cases with the combination of aripiprazole and risperidone/paliperidone, there were 2 cases 13,14 of concurrent atypical LAI antipsychotics. Both cases described clinical improvement after the second atypical antipsychotic was added orally.…”

Section: Discussionmentioning

confidence: 99%

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The use of concurrent long-acting injectable antipsychotic therapy with paliperidone palmitate and aripiprazole monohydrate in a patient with schizophrenia

Evernden¹,

Giang

Anderson

2021

Mental Health Clinician

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International schizophrenia guidelines endorse seeking the patient's preference for guiding antipsychotic therapy. There exists a small niche of patients who prefer, or are required to use, long-acting injectable antipsychotic medications due to the adherence benefit. However, they may not be able to achieve adequate symptom reduction prior to experiencing treatment-limiting adverse effects from a single agent. Here, we present a patient case prescribed concurrent long-acting injectable antipsychotic therapy with paliperidone palmitate and aripiprazole monohydrate due to patient preference in the setting of a history of nonadherence to oral medications, treatment-limiting adverse effects to long-acting injectable paliperidone, and failure to achieve adequate symptom reduction with long-acting injectable aripiprazole monotherapy.

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Multiple Long-Acting Injectable Antipsychotics for Treatment-Resistant Schizophrenia

Cited by 7 publications

References 9 publications

Schizophrenia treatment with a combination of two LAI antipsychotics: A case report

Schizophrenia treatment with a combination of two LAI antipsychotics: A case report

Consideration of Long-Acting Injectable Antipsychotics for Polypharmacy Regimen in the Treatment of Schizophrenia: Put It on the Table or Not?

The use of concurrent long-acting injectable antipsychotic therapy with paliperidone palmitate and aripiprazole monohydrate in a patient with schizophrenia

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