The long-acting depot antipsychotic drugs

Pandarakalam, James Paul

doi:10.12968/hosp.2003.64.10.2327

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…Other benefits include more consistent bioavailability [Remington and Adams, 1995] and more predictable correlation between dosage and plasma levels [Rocca et al 2013], reduced peaktrough plasma levels [McEvoy, 2006], improved patient outcomes [Peuskens et al 2010a;Kaplan et al 2013], improved patient and physician satisfaction [Peuskens et al 2010b], lower relapse rates [Emsley et al 2008a[Emsley et al , 2008bGaebel et al 2010] than oral therapy and more regular contact with the mental healthcare team [Pandarakalam, 2003].…”

Section: Disadvantagesmentioning

confidence: 99%

“…The pros and cons associated with the use of LAI formulations are summarized in Table 2. LAI APs offer a number of advantages compared with oral medication, including not having to remember to take drugs daily, reducing the risk of unintentional or deliberate overdose, and transparency of adherence [Gerlach, 1995;Remington and Adams, 1995], allowing healthcare professionals to be alerted and to intervene appropriately if patients fail to take their medication [NICE, 2009]. When patients stop medication, plasma levels decrease more slowly than with oral [Gerlach, 1995;Remington and Adams, 1995] • Allows healthcare professionals to be alerted and to intervene appropriately if patients fail to take their medication [NICE, 2009] • Less probability for rebound symptoms and rapidly occurring/abrupt relapses • Overcome partial adherence or overt nonadherence • If a relapse occurs, it is due to other reasons beyond noncompliance [Waddell and Taylor, 2009] • Reduced risk of unintentional or deliberate overdose [Gerlach, 1995;Remington and Adams, 1995] • Lower relapse rates [Walburn et al 2001;De la Gándara et al 2009;Gabel et al 2010;Kane et al 2010] • Minimal gastrointestinal absorption problems, circumventing first-pass metabolism [Dencker, 1984;Marder et al 1989] • More consistent bioavailability [Waddell and Taylor, 2009] • More predictable correlation between dosage and plasma levels [Rocca et al 2013] • Reduced peak-trough plasma levels [McEvoy, 2006] • Improved patient outcomes [Olfson et al, 1999] • Improved patients' and physicians' satisfaction [Peuskens et al 2010] • Regular contact between the patient and mental healthcare team [Pandarakalam, 2003]…”

Section: Potential Advantages and Disadvantages Of Lai Apsmentioning

confidence: 99%

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The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal

Brissos¹,

Ruiz‐Veguilla

Taylor

et al. 2014

Therapeutic Advances in Psychopharmacology

232

200

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Historical background of long-acting injectable antipsychotics Soon after the introduction of antipsychotics (APs) in the 1950s, poor adherence to oral formulations was found to be a critical issue. This led to the development in 1966 of the first long-acting injectable (LAI) AP fluphenazine enanthate, and fluphenazine decanoate some 18 months later, to reduce the incidence of side effects of the former [Johnson, 2009]. Haloperidol decanoate became available in Europe in 1981 and in the USA in 1986 [Knudsen, 1985]. Clinical trial results showed a dramatic reduction in the morbidity of schizophrenia [Gottfries and Green, 1974; Johnson, 2009]. However, the concept of LAIs for schizophrenia was not initially received warmly by the medical profession for fears of increased side effects, lack of efficacy, and the fact this was seen as an attempt by psychiatrists to impose a treatment upon patients without due regard to their feelings or rights [Johnson, 2009] as well as the potential for medicolegal problems [Glazer and Kane, 1992]. However, with subsequent surveys and trials suggesting their benefits [Rifkin et al. 1977; Schooler et al. 1980; Hogarty et al. 1979], LAIs became more widely adopted. The introduction of the oral second-generation APs (SGAs) brought claims of better tolerance and less severe side effects, even though their use may be hindered by metabolic syndrome [Meyer and Stahl, 2009]. They also have potential to prevent or reverse accelerated frontotemporal cortical grey matter decline, and to provide a greater degree of neuroprotection than first generation APs (FGAs) [Keefe et al. 2004; Robinson et al. 2006]. The introduction of SGAs led to a decline in the use of LAI FGAs [Patel et al. 2003; Patel and David, 2005]. However, it soon became clear that atypical characteristics did not bring better adherence rates with oral SGAs. The recent introduction of LAI SGAs allows psychiatrists once

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Section: Disadvantagesmentioning

confidence: 99%

Section: Potential Advantages and Disadvantages Of Lai Apsmentioning

confidence: 99%

The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal

Brissos¹,

Ruiz‐Veguilla

Taylor

et al. 2014

Therapeutic Advances in Psychopharmacology

232

200

View full text Add to dashboard Cite

show abstract

“…Other benefits of LAI antipsychotics include a reliable drug delivery with reduced peak–trough plasma levels [19], improved patient outcomes [20], improved patient and physician satisfaction [21] and lower relapse rates [22-24] than oral therapy. Furthermore, with LAI antipsychotics, there is regular contact between the patient and treatment team [25]. …”

Section: Introductionmentioning

confidence: 99%

“…Attributes that may influence prescribing of long-acting formulations and patient acceptance include stigma [32], pain associated with injection [19] and embarrassment arising from the need to remove clothing for gluteal injections [25]. Although first-generation depot antipsychotics that use oil-based formulations are associated with pain on injection [19], aqueous-based formulations of LAI antipsychotics generally have good injection site tolerability [19].…”

Section: Introductionmentioning

confidence: 99%

Attitudes towards the administration of long-acting antipsychotics: a survey of physicians and nurses

Geerts

Martínez²,

Schreiner

2013

BMC Psychiatry

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BackgroundDiscontinuation of antipsychotic treatment for schizophrenia can interrupt improvement and exacerbate the illness. Reasons for discontinuing treatment are multifactorial and include adherence, efficacy and tolerability issues. Poor adherence may be addressed through non-pharmacological approaches as well as through pharmacological ones, ie ensured delivery of medication, such as that achieved with long-acting injectable (LAI) antipsychotics. However, attitudes of healthcare professionals (HCPs) towards LAI antipsychotics may influence their prescribing decisions and may influence medication choices offered to patients. We therefore conducted a survey to investigate factors driving LAI use as well as physician and nurse attitudes to LAI antipsychotics and to different injection sites.MethodsAn independent market research agency conducted the survey of HCPs across Europe. Participants were recruited by telephone and completed the survey online. Using conjoint analyses (a multivariate statistical technique analysing preferences on the basis of ranking a limited number of attributes which are presented repetitively), attitudes to oral versus LAI medication and gluteal versus deltoid injection routes were assessed.ResultsA total of 891 HCPs across Europe were surveyed. Of these, 40% would choose LAI antipsychotics for first episode patients whereas 90% would select LAI antipsychotics for chronic patients with two to five psychotic episodes. Dominant elements in antipsychotic choice were low sedation but no tardive dyskinesia, no or mild pain at injection and low risk of embarrassment or impact upon therapeutic alliance. Eighty-six per cent of respondents considered that having the choice of a deltoid as well as gluteal administration site was beneficial over not having that choice. Two thirds of respondents said they agreed that medication administration via the deltoid muscle may reduce social embarrassment associated with LAI antipsychotics and most respondents (61%) believed that administration of LAI antipsychotics into the deltoid muscle as opposed to the gluteal muscle may be more respectful to the patient.ConclusionsIn this survey of physicians and nurses, attitudes towards LAI antipsychotics compared with oral medication were generally positive. Respondents considered that the availability of a deltoid administration route would offer increased choice in LAI antipsychotic administration and may be perceived as more respectful and less socially embarrassing.

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“…One of the significant factors in the prevention of schizophrenia relapse is the use of antipsychotics, and to better compliance helps the use of long-acting antipsychotics, which received over a half of the inpatients, compared to almost the majority of the pa-tients treated at Day Hospital. Although no statistically significant difference was found in the distribution of long-acting antipsychotics used in the comparable patient groups, we can assume that patients treated at Day Hospital were more aware of the need to take long-acting antipsychotics and their usefulness, resulting in a lower relapse rate and a better outcome of the disorder, as discussed by a number of studies [35][36][37][38].…”

Section: Discussionmentioning

confidence: 81%

Comparison of Clinical and Sociodemographic Characteristics of Patients with Schizophrenia Treated Stationary and at Day Hospital

Blažinović

Orlović²,

Karlović

et al. 2019

Arch. Psychiatry Res.

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The contemporary concept of treating schizophrenia tends to achieve functional remission, reducing the number and length of hospitalizations and improving the quality of life of patients. The aim of this study was to identify and compare the sociodemographic and clinical characteristics of patients with schizophrenia treated stationary and those treated at Day Hospital. This study, with the four month time interval, randomly included 60 participants with schizophrenia aged 18 to 55, who were divided into two groups. First group of 30 participants was treated only stationary, and the other 30 participants were treated only at Day Hospital. Each participant completed a sociodemographic and clinical characteristics questionnaire which was created for the purpose of this research. The results showed that participants treated at Day Hospital are younger, have a higher education level, and are more capable of working and functioning adequately. They are also more likely to receive psychiatric treatment from the early stages of their illness. Furthermore, participants treated in the Day Hospital setting have been less frequently hospitalized due to their illness (fewer acute episodes) than inpatients, which was statistically significant (t = 3,763; p = 0,001), as a consequence of which they have a longer remission periods. This could contribute to better personal and social functioning, as well as to a better management of daily life, and thus implies a higher level of life quality compared to the inpatients.

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The long-acting depot antipsychotic drugs

Cited by 9 publications

References 27 publications

The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal

The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal

Attitudes towards the administration of long-acting antipsychotics: a survey of physicians and nurses

Comparison of Clinical and Sociodemographic Characteristics of Patients with Schizophrenia Treated Stationary and at Day Hospital

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