Schizophrenia Part 3

ASK YOUR PHARMACIST

Long acting anti-psychotic injections (For Schizophrenia)

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

I previously discussed long-acting antipsychotic injections Westmeath Examiner due to a query from a person who is prescribed them for schizophrenia. First-generation antipsychotic (FGA) long-acting injections were introduced in the 1960s. The first of the second-generation antipsychotic long acting injections (LAI) (risperidone LAI) became available in 2002 and since then Xeplion^® (paliperidone) injection has come on the market. For the purpose of this article I refer to long-acting injection versions of antipsychotics as LAIs. This article discusses second-generation antipsychotic LAIs in a little more detail than I did in my previous Examiner article on LAIs.

Why used?

According to studies, approximately 40–60% of patients with schizophrenia do not take their medication regularly and in many cases refuse to take it at all. Long-acting injections are often prescribed when a patient is not taking their oral medication as prescribed. Many decide to use them as they offer the convenience of not taking a tablet every day and in some cases where a tablet did not work. LAIs require the attendance to a clinic for regular injection every 1–6 weeks.  This ensures the medication is given regularly and allows regular review of treatment. LAIs do not guarantee the patient will not relapse but they greatly reduce the risk.

Comparing Long-acting injectable antipsychotics (LAIs) to oral antipsychotics

A 2011 study published in the New England Journal of Medicines found that, in high-risk patients with schizophrenia and schizoaffective disorder, long-acting injectable risperidone did not provide great improvements to key outcomes such as psychiatric symptoms, quality of life or functioning when compared with oral antipsychotics (tablet versions). However, other studies have shown that LAIs give very favourable results when compared to oral antipsychotics and that they reduce hospitalisations by up to 34% when compared to oral antipsychotics and reduce relapses by between 10 and 30% when compared to oral antipsychotics.

Second-generation long-acting antipsychotic injections

Risperidone was the first of the second generation LAIs to be licensed in the UK and Ireland. The drug will not reach a therapeutic level for a few weeks after injection; therefore it is essential that the patient receive supplementary antipsychotic medication (tablet form) during the initial period of treatment following the first injection. It is administered into the gluteus (buttocks) or deltoid (upper arm) muscle every two weeks.

Xeplion^® (paliperidone) injection is the newest LAI; it only needs to be administered once monthly. Paliperidone is effective in relieving both positive symptoms (hallucinations, disturbances of thought, hostility) and negative symptoms (lack of emotion and social withdrawal) of schizophrenia, whereas older antipsychotics are usually less effective against the negative symptoms Paliperidone also relieves 'affective symptoms' that are associated with schizophrenia, such as depression, guilt feelings or anxiety.

For more information, call into Whelehans for a free copy of Eamonn’s comprehensive article on injections used for schizophrenia; he also discusses the older first-generation antipsychotic LAIs (commonly called ‘depot’ injections) such as Zuclopenthixol (Clopixol^®) such as Flupenthixol (Depixol^®). The information is also available at www.whelehans.ie. We also have a comprehensive article on schizophrenia.

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans