Long-Acting Injectable Antipsychotic Medications in Pregnancy: A Review

Abstract Background Antipsychotic medications are evidence-based treatments for schizophrenia that improve health outcomes and reduce costs. However, rates of non-adherence to oral antipsychotic medications can exceed 60%. We examined whether a simple checklist to identify individuals not receiving optimum benefit from current oral antipsychotic treatment (NOB Checklist) and The Multi-level Facilitation of Long-acting Antipsychotic Medication Program (MAP) could increase the appropriate use of long-acting injectable antipsychotic medication (LAI) in community clinics. Methods Two clinics in Texas and two in Ohio changed clinical procedures in one of two ways 1) NOB only clinics--providers used a five-item checklist to identify individuals with schizophrenia on oral antipsychotics who were Not receiving Optimum Benefit from current treatment and may therefore benefit from a switch to LAI. 2) MAP- providers used the NOB checklist AND received MAP; MAP is a novel behavior change intervention designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer for whom peer specialists showed a video describing shared decision making and how to make a choice between tablets and injections, and provided a balanced shared-decision making tool to assist them in choosing medication route,2) the provider who received academic detailing describing various LAI options, how to make good offers as part of a shared decision making dialogue, and important benefits of LAI including the ability to disentangle efficacy versus poor adherence and to help individuals with cognitive and practical problems that lead to poor adherence, and 3) the administrators who received information on how LAI could improve outcomes for individuals and clinic processes, how to encourage the use of LAI among providers and how to provide regular feedback to providers about prescribing practices. The primary outcome was the percentage of LAI versus oral antipsychotic medication prescribed to individuals with schizophrenia. Results Higher NOB checklist scores were associated with an increased provider likelihood of LAI offers and increased consumer acceptance of LAI. All clinics increased use of LAI over time. In Texas, where MAP was fully implemented, the MAP clinic had greater use of LAI over time (eventually reaching about 50% of all antipsychotic use) vs. the NOB only clinic. In Cleveland, the patient stakeholder curriculum was not delivered and there was no significant difference in LAI use between MAP and NOB clinics. Discussion The NOB checklist appears to be a useful tool to help identify patients who might be appropriate candidates for LAI and the full MAP program may help clinicians and consumers to work together to optimize the appropriate use of LAI in outpatient settings. Implementation must be customized for clinics and workflows to determine which parts of the MAP program are practical and appropriate. Participation of consumer stakeholders may be essential to delivery of the MAP Program.

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Subcutaneous Extended-Release Buprenorphine Use in Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2020/3127676 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Craig V. Towers ◽

Heather Deisher

Keyword(s):

Extended Release ◽

Opioid Use Disorder ◽

Adverse Outcomes ◽

Extensive Literature ◽

Opioid Use ◽

Sublingual Buprenorphine ◽

Medication Assisted Treatment ◽

Urine Drug ◽

Long Acting ◽

In Pregnancy

Background. Opioid use disorder (OUD) in pregnancy is managed by medication-assisted treatment. Sublingual buprenorphine is one option, but subcutaneous extended-release buprenorphine (Sublocade®) is an alternate form administered in monthly injections. Through an extensive literature search, we did not find any prior publication on the use of Sublocade in pregnancy. Case. Two patients with OUD switched from sublingual buprenorphine to Sublocade. One patient received a total of eight injections and then discovered she was pregnant. Based on ultrasound dating, the last 5 administrations occurred during her pregnancy. The second patient received 6 injections with the last occurring at the time of her last menstrual period. Both declined further injections, as well as oral buprenorphine. Serial urine drug screens remained positive for buprenorphine through delivery in both cases. Neither the mothers nor the neonates experienced withdrawal symptoms or adverse outcomes. No birth anomalies were found. Discussion. Though further research is needed regarding the use of Sublocade in pregnancy, it is likely that other pregnancies will occur during this treatment modality. If this long-acting form of buprenorphine medication is found to be safe, it might play a role in managing some pregnant patients with OUD.

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

Mental Health Clinician ◽

10.9740/mhc.2021.09.305 ◽

2021 ◽

Vol 11 (5) ◽

pp. 305-310

Author(s):

Christopher Evernden ◽

Irene Giang ◽

Mariah Anderson

Keyword(s):

Adverse Effects ◽

Single Agent ◽

Paliperidone Palmitate ◽

Symptom Reduction ◽

Patient Case ◽

Antipsychotic Therapy ◽

Antipsychotic Medications ◽

Oral Medications ◽

History Of ◽

Long Acting

Abstract 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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Long-Acting Antipsychotic Medications

Current Drug Targets ◽

10.2174/138945012799499785 ◽

2012 ◽

Vol 13 (4) ◽

pp. 555-560 ◽

Cited By ~ 7

Author(s):

Raman Baweja ◽

Karim Sedky ◽

Steven Lippmann

Keyword(s):

Antipsychotic Medications ◽

Long Acting

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Asthma during Pregnancy: Exacerbations, Management, and Health Outcomes for Mother and Infant

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0037-1600906 ◽

2017 ◽

Vol 38 (02) ◽

pp. 160-173 ◽

Cited By ~ 16

Author(s):

Megan Jensen ◽

Peter Gibson ◽

Vanessa Murphy

Keyword(s):

Pregnant Women ◽

Inhaled Corticosteroids ◽

Management Strategies ◽

Perinatal Outcomes ◽

Severe Exacerbation ◽

Complex Needs ◽

Oral Corticosteroids ◽

Management Approaches ◽

Long Acting ◽

In Pregnancy

AbstractOne in 10 pregnant women worldwide has asthma and of these, 10% will have a severe exacerbation requiring oral corticosteroids (OCSs) in pregnancy. This review of recent publications in the field will describe the effects of exacerbation on maternal and neonatal health, the use of asthma medications during pregnancy, and will suggest novel management approaches for asthma in pregnancy. Pregnancy results in unpredictable changes in the disease; therefore, regular monitoring of symptoms is recommended. Uncontrolled asthma is frequently described in cohorts of pregnant women with asthma, and some recent studies show associations with adverse perinatal outcomes, as previously demonstrated with exacerbations. Guidelines for the management of asthma recommend the continued use of inhaled corticosteroids (ICSs) in pregnancy, with budesonide having a particularly good safety profile. Recent data suggest small effects of asthma and/or asthma medication use on congenital malformations; however, there is less data available on the safety of ICS/long-acting β agonist combinations, which are increasingly used for maintenance treatment. Novel management strategies are needed to address the complex needs of pregnant women with asthma. These include medication nonadherence and the presence of numerous comorbidities which can affect asthma, such as rhinitis, cigarette smoking, obesity, and mental health issues. Inflammation-based management has been shown to be effective in reducing exacerbations in pregnancy and may also improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment of comorbidities have potential to improve the health of mothers and their offspring.

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