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TABLE 2. Advantages and Disadvantages of Long-Acting Injectable Antipsychotics
ADVANTAGES DISADVANTAGES
  • Adherence benefits (potential for improved adherence, delayed onset of nonadherence)
  • Earlier detection of nonadherence (allows for rapid intervention, helps differentiate nonadherence from poor medication efficacy)
  • Simplification of medication routine (eliminates daily dosing of oral medications, fewer day-to-day reminders of illness)
  • Pharmacokinetics/pharmacodynamics properties (more stable serum concentrations reduce side effects and symptoms related to peak and trough plasma concentrations, greater flexibility in dosing scheduling due to long half-life, reduced risk of withdrawal symptoms or symptom exacerbation)
  • Possibility of attaining lowest effective dose with step-wise reduction
  • Reduced risk of medication overdose
  • Do not solve all adherence issues (due to patient refusal or discontinuation of LAIAs)
  • Negative patient perception of LAIAs (stigma, coercion, or use as a tracking method)
  • Lack of availability of LAI formulations/fewer medication options than oral antipsychotics
  • Pharmacokinetics/pharmacodynamics properties (conversion from oral to LAIAs may be challenging, initiation may require initial oral supplementation, lack of flexibility in changing/adjusting doses, not immediately reversible if adverse effects develop)
  • Possible injection-site reactions
  • Risk of post-injection delirium/sedation syndrome (olanzapine)
  • Higher direct medication cost of LAIAs compared with oral formulations

Derived from Weiden PJ, Turkington D. Assessment and management of medication nonadherence in schizophrenia. In: Lieberman JA, Murray RM, eds. Comprehensive Care in Schizophrenia. A Textbook of Management, 2nd Edition. New York, NY: Oxford University Press USA, 2012, 219-243; Patel MX, David AS. Why aren’t depot antipsychotics prescribed more often and what can be done about it? Advances in Psychiatric Treatment. 2005;11(5):203-213.