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

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.

Discontinuation, read missions and polytherapy with long-acting antipsychotics: An observational study

2016 ◽  
Vol 33 (S1) ◽  
pp. S540-S540
Author(s):  
I. García Cabeza ◽  
P. Pérez Marín ◽  
H. De Diego
Keyword(s):  
Observational Study ◽  
First Generation ◽  
Paliperidone Palmitate ◽  
Categorical Variables ◽  
Anticholinergic Drugs ◽  
Psychoactive Drugs ◽  
Oral Medications ◽  
Competing Interest ◽  
Long Acting

Introduction and aimLong-acting antipsychotics (LAIs) provide certain advantages over oral medications. The aim of our study is to determine whether there are differences between the various long-acting injectable antipsychotics available in our environment.MethodsA retrospective observational study with psychotic patients discharged with LAIs was designed. Data on discontinuation, relapses and associated drugs in the discharge and in a year follow-up were collected. Fifty-seven patients were included: 21 risperidone (RLAI), 20 paliperidone palmitate (PP) and 16 first-generation LAIs (FG). Odds ratio was used to compare discontinuation, χ2 test for categorical variables and Kruskal-Wallis test for independent samples.ResultsDiscontinuation was lower with PP: ORRLAI/PP = 2.74 and ORFGLAI/PP = 3.09. There were significant differences in readmissions: rehospitalizations (χ2 = 7.072, P = 0.029) and days of stay (χ2 = 8.251; P = 0.016), both lower in the PP group. We found less use of psychoactive drugs with PP, with significant differences in the discharge (χ2 = 11.518; P = 0.003) and in the follow-up (χ2 = 7.097; P = 0.029). There were also significant differences in the use of oral antipsychotics in the discharge (χ2 = 27.049, P = 0.000); anticholinergic drugs in the discharge (χ2 = 7.001, P = 0.03) and in the follow-up (χ2 = 11.699, P = 0.003) and benzodiazepines in the follow-up (χ2 = 8.493, P = 0.014), always lower in the group of patients treated with PP.ConclusionsTreatment with paliperidone palmitate may be more suitable than other long acting antipsychotics when it starts during the acute episode.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Paliperidone Palmitate-Induced Delirium in an Adolescent with Schizophrenia: Case report

2018 ◽  
Vol 18 (2) ◽  
pp. 208 ◽  
Author(s):  
Hassan Mirza ◽  
Duncan Harding ◽  
Naser Al-Balushi
Keyword(s):  
Case Report ◽  
Early Adulthood ◽  
Antipsychotic Agents ◽  
Acute Onset ◽  
Paliperidone Palmitate ◽  
Adolescent Male ◽  
Psychotic Symptoms ◽  
National Health Service Foundation ◽  
Oral Medications ◽  
Long Acting

Schizophrenia is a serious long-term mental disorder which usually presents in adolescence or early adulthood. However, poor adherence to oral antipsychotics can lead to relapse and rehospitalisation. We report an adolescent male with schizophrenia who was referred to the South London & Maudsley National Health Service Foundation Trust, London, UK, in 2015 due to worsening psychotic symptoms. Following poor compliance with oral medications, a four-week regimen of paliperidone palmitate long-acting injections was initiated, with an initial positive response. However, 10 days after the second dose, the patient developed severe acute-onset delirium with fluctuating levels of consciousness. Paliperidone palmitate was discontinued and the patient instead underwent a course of zuclopenthixol decanoate long-acting injections with a favourable outcome.Keywords: Adolescent Psychiatry; Schizophrenia; Antipsychotic Agents; Delirium; Paliperidone Palmitate; Zuclopenthixol; Case Report; United Kingdom.

Treatment with intramuscular paliperidone palmitate in schizoaffective disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S581-S581
Author(s):  
L. Maroto Martin ◽  
P. Hervías Higueras
Keyword(s):  
Schizoaffective Disorder ◽  
Complex Disease ◽  
Psychotic Disorders ◽  
Paliperidone Palmitate ◽  
Valuable Treatment ◽  
History Of ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Monthly Dose

IntroductionInjectable formulations of long acting antipsychotic are a valuable treatment option for patients with psychotic disorders. Schizoaffective Disorder (SAD) is a complex disease; the optimal treatment is not well established yet.ObjectiveAnswer the question about the effectiveness offered by intramuscular Paliperidone Palmitate in SAD versus other injectable antipsychotics. Keywords: schizoaffective disorder; paliperidone palmitate injection.MethodsA case report of a 35-year-old male diagnosed with Schizoaffective Disorder six years ago and with personal history of multiple manic decompensation after treatment discontinuation. Throughout his life he has been treated with intramuscular Risperidone 87.5 mg (50 + 37.5) every 14 days, Olanzapine flas 20 mg/day, Risperidone flas 3 mg, Amisulpride 600 mg/day, Valproic acid 1500 mg/day Clonazepam 2 mg/day and Lormetazepam 1 mg. In the last admission one year ago, he started treatment with intramuscular paliperidone palmitate up to 200 mg a month. Currently he receives a monthly dose of 100 mg and concomitant lithium 800 mg/day.DiscussionThe use of intramuscular paliperidone palmitate in SAD and its effectiveness against other injectable antipsychotic is discussed.ConclusionsThe use of intramuscular paliperidone palmitate appears to constitute an employment opportunity in the treatment of intramuscular maintenance in SAD. It could be effective in stabilizing episodes of acute exacerbation and remissions of psychotic, manic and depressive symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Therapeutic attitudes and clinical global impression: A 2-year follow-up study of 33 outpatients with a mental disorder in treatment with paliperidone palmitate

2016 ◽  
Vol 33 (S1) ◽  
pp. S616-S617
Author(s):  
M.D. Perez Lopez ◽  
M. Soto laguna ◽  
J. Prados Gomez ◽  
I. Zarranz Herrera Oria ◽  
R. Perez Asenjo ◽  
...  
Keyword(s):  
Mental Disorder ◽  
Clinical Global Impression ◽  
Paranoid Schizophrenia ◽  
Paliperidone Palmitate ◽  
Antipsychotic Therapy ◽  
Attitude Inventory ◽  
Axis I ◽  
Long Acting ◽  
Drug Attitude Inventory ◽  
Drug Attitude

IntroductionMaintaining antipsychotic therapy in mental disorder is important in preventing relapse, rehospitalization, and suicide. Lack of awareness of illness may be a leading cause for non-adherence. Long-acting depot can prevent non- adherence and thus potentially contribute to better patient outcomes.ObjectiveThe aim of this prospective, observational, non interventional 2-year-long study is to assess severity and post-intervention changes and attitudes toward medication of a group of patients treated paliperidone palmitate (PP).MethodsThirty-three outpatients stabilised with PP during the last 24 months. Inclusion criteria were: patients’ age (> 18 years), a diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder stabilised during the last 12 months with PP, without a diagnostics from axis I or II (except for nicotine of caffeine) and able to sign the inform consent. Data collected: general sociodemographic and clinical data (age, sex, level of education, socioeconomic situation, family support, psychiatric diagnosis, years of evolution, use/abuse of substances, treatment, previous and later number of hospitalisations. Evaluations included disease severity (Clinical Global Impression-Severity (CGI-S) and Drug Attitude Inventory, (DAI)).ResultsThirty-threeoutpatients were followed during 24 months [mean dose 132,58 (44,4) mg], 75,8% were men, age 45,05 years old, 87,8% with a diagnoses of paranoid schizophrenia. Antipsychotic monotherapy increased over the time with PP. Significant improvements were observed on both Clinical Global Impression and Drug Attitude Inventory. The number of rehospitalizations and mean stays decreased from the beginning until the end of these 24 months.ConclusionsOur results suggest an improvement in the patient's clinical vision and attitude towards medication with long-acting depot.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Emerging pharmacological therapies in schizophrenia: what’s new, what’s different, what’s next?

CNS Spectrums ◽  
2016 ◽  
Vol 21 (S1) ◽  
pp. 1-12 ◽  
Author(s):  
Leslie Citrome
Keyword(s):  
Adverse Effects ◽  
Tardive Dyskinesia ◽  
Maintenance Treatment ◽  
Clinical Development ◽  
Phase Iii ◽  
Time Interval ◽  
Antipsychotic Therapy ◽  
Partial Agonists ◽  
Long Acting ◽  
Novel Antipsychotic

There are several new and emerging medication interventions for both the acute and maintenance treatment phases of schizophrenia. Recently approved are 2 new dopamine receptor partial agonists, brexpiprazole and cariprazine, as well as 2 new long-acting injectable antipsychotic formulations, aripiprazole lauroxil and 3-month paliperidone palmitate. Although differences in efficacy compared to other available choices are not expected, the new oral options offer different tolerability profiles that may be attractive for individual patients who have had difficulties with older medications. The new long-acting injectable options provide additional flexibility in terms of increasing the time interval between injections. In Phase III of clinical development is a novel antipsychotic, lumateperone (ITI-007), that appears to have little in the way of significant adverse effects. Deutetrabenazine and valbenazine are agents in Phase III for the treatment of tardive dyskinesia, a condition that can be found among persons receiving chronic antipsychotic therapy. On the horizon are additional injectable formulations of familiar antipsychotics, aripiprazole and risperidone, that may be more convenient than what is presently available.

Long-acting injectable antipsychotics: what, when, and how

CNS Spectrums ◽  
2021 ◽  
pp. 1-12
Author(s):  
Leslie Citrome
Keyword(s):  
United States ◽  
First Generation ◽  
The United States ◽  
Paliperidone Palmitate ◽  
Fluphenazine Decanoate ◽  
History Of ◽  
Olanzapine Pamoate ◽  
Receive Treatment ◽  
Long Acting ◽  
Current Guidelines

Abstract Current guidelines for the treatment of patients with schizophrenia advocate that patients receive treatment with a long-acting injectable (LAI) antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence. Available LAI formulations in the United States include first-generation antipsychotics (fluphenazine decanoate and haloperidol decanoate), risperidone/paliperidone containing products (risperidone microspheres, paliperidone palmitate, and risperidone subcutaneous), aripiprazole containing products (aripiprazole monohydrate and aripiprazole lauroxil), and olanzapine pamoate. LAI antipsychotics can address the guesswork about adherence status and patients may prefer them if they are offered this as a choice, including individuals early in their disease course. Additional approved indications in the United States for LAI antipsychotics include bipolar I disorder maintenance treatment for risperidone microspheres and aripiprazole monohydrate, and schizoaffective disorder for paliperidone palmitate once monthly. Differences and similarities among the different products are discussed, including guidance regarding optimal treatment selection. Tips are provided to enhance effective patient communication to maximize the likelihood of acceptance of this treatment modality.

Real-World Utilization Patterns of Long-Acting Injectable Antipsychotics in Canada: A Retrospective Study

2021 ◽  
pp. 070674372110554
Author(s):  
Ofer Agid ◽  
Gary Remington ◽  
Carmen Fung ◽  
Natalie M. Nightingale ◽  
Marc Duclos ◽  
...  
Keyword(s):  
Real World ◽  
Prescription Data ◽  
Antipsychotic Therapy ◽  
Antipsychotic Medications ◽  
Schizophrenia Spectrum ◽  
Utilization Patterns ◽  
Third Line ◽  
One Year ◽  
Long Acting ◽  
Line Of Therapy

Objective: The objective of this study was to analyze the real-world prevalence of long-acting injectable (LAI) antipsychotic use and determine when LAIs are being used in sequencing of antipsychotic medications among Canadian patients with schizophrenia. Methods: This was a retrospective, longitudinal cohort study using Canadian pharmacy prescription data between August 2005 and June 2017. Patients with inferred schizophrenia spectrum disorder were indexed on the date of their first antipsychotic prescription and analyzed for minimum 12 months to track lines of antipsychotic therapy and LAI utilization. Results: A total of 16,300 patients were identified for analysis. 48.2% and 46.0% of index antipsychotic prescriptions were prescribed by a general practitioner/family medicine doctor and psychiatrist, respectively. 1,062 (6.5%) patients used an LAI during the study period. Of those patients, 789 used an LAI within two years of index (74.3% of LAI users; 4.8% of all patients). The majority of LAI use (62.0%) occurred in the third line of therapy or later. 65.0% of patients had tried at least two therapy lines, and most patients reported gaps of six months to one year between treatment lines. Conclusion: Despite their potential to reduce relapse in schizophrenia by improving treatment adherence, this study shows LAIs continue to be under-utilized in Canada. When used, LAIs are positioned late in sequencing of antipsychotic medications, often not initiated until years after diagnosis. Continued preference for oral APs with poor adherence may be negatively impacting prognosis and exacerbating burden of schizophrenia. Efforts should be invested to understand barriers to LAI uptake and advocate for earlier, widespread use of LAIs.

Going the distance: reviewing antipsychotic depot or long-acting injectable treatments in Australasia

2018 ◽  
Vol 26 (3) ◽  
pp. 303-306
Author(s):  
Theo Theodoros ◽  
Mark Taylor ◽  
Hannah Chu-Han Huang ◽  
Nancy Wang ◽  
Balaji Motamarri
Keyword(s):  
Medication Adherence ◽  
Therapeutic Option ◽  
Paliperidone Palmitate ◽  
Significant Advance ◽  
Recent Experience ◽  
Antipsychotic Medications ◽  
Treatment Choices ◽  
Long Acting ◽  
Informed Patient

Objectives: The aim of this study is to provide an opinion paper reviewing the role of depot or long-acting injectable (LAI) antipsychotic medications, with comments on individual newer LAIs such aripiprazole maintena and paliperidone palmitate. In particular, we share our recent experience of using paliperidone three-monthly LAI. We also reflect on the associated benefits and potential harms of LAIs, and when they may be used. Conclusions: LAI antipsychotics are an important and arguably under-utilised therapeutic option, particularly where medication adherence is a priority, and where an informed patient opts for this formulation. Paliperidone is the first three-monthly LAI antipsychotic, and as such represents a significant advance in the range of treatment choices.

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