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http://intranep/TeamCentre/pharm/PublishedDocuments/nepft-antipsychotic-long-acting-injections-guidance-120306-2.doc
CG/Antipsychotic LAI/03/15 Implementation Date: March 2015 Review Date: March 2018
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CONTENTS
http://intranep/TeamCentre/pharm/PublishedDocuments/nepft-antipsychotic-long-acting-injections-guidance-120306-2.doc
CG/Antipsychotic LAI/03/15 Implementation Date: March 2015 Review Date: March 2018
Page 2 of 7
Guidance For The Use Of Antipsychotic Long-Acting
Injections In North Essex
1. Introduction
Long-acting or depot antipsychotic injections can be a useful form of administering
antipsychotics. The introduction of atypical injections has produced an increased
pressure on the drug budget, which may be justified if it can be shown to save
hospital admissions, length of stay and show an improved quality of life compared
with the alternatives available.
2. Aim
This guidance is to provide information about the choice of antipsychotic long-acting
injections available.
3. Scope
All practitioners within the North Essex Partnership University NHS Foundation Trust
(NEP) and the associated primary care areas of Mid, West and North East Essex.
5. Guidance
5.2 Disadvantages
Once it has been administered it cannot be removed if side-effects develop
(dystonia, EPSE, NMS)
Perception by the patient of being controlled, losing control over their
treatment, or possibly being a punishment.
Pain at the site of injection, lasting possibly 10 days
Tissue necrosis. Over time hard plaques may form, which will reduce the
ease of administration and the efficacy of the injection as well as causing
discomfort.
Loss of dignity with the gluteal route
http://intranep/TeamCentre/pharm/PublishedDocuments/nepft-antipsychotic-long-acting-injections-guidance-120306-2.doc
CG/Antipsychotic LAI/03/15 Implementation Date: March 2015 Review Date: March 2018
Page 3 of 7
5.3 Choice of injection (when oral medication has already been considered)
st
Paliperidone LAI –(1 Choice) or
nd
Risperidone Consta LAI (2 Choice)
If there are no mitigating factors the oily depot injections should be first choice (most
cost-effective). The efficacy for the treatment of schizophrenia is similar, but the side
effects profile is different for each one. Risperidone Consta and Paliperidone are less
effective for people with treatment-resistant illness. They are both much more
expensive than the oily depot injections, which should be considered first.
For comparisons, please see www.choiceandmedication.org.uk/nepft for more
information, or “Psychotropic Directory” Steve Bazire. A brief table to compare the
properties of these injections has been devised below.
http://intranep/TeamCentre/pharm/PublishedDocuments/nepft-antipsychotic-long-acting-injections-guidance-120306-2.doc
CG/Antipsychotic LAI/03/15 Implementation Date: March 2015 Review Date: March 2018
Page 4 of 7
Injection Route Dose for Duration Peak Time to Comment
adults of action (days) steady
under 65 (weeks) state
(weeks)
Aripiprazole Gluteal or 400mg Data not 5-7 16 By Form B
deltoid monthly, available. application to
Maintena
continue oral May MMG only
aripiprazole depend on
10-20mg for route and
14 days after dose
injection
Flupentixol GlutealLateral Test 20mg 3-4 7-10 10-12 C/I if circulatory
thigh Maintenance collapse or loss of
decanoate 50mg 4- consciousness.
weekly to May cause
300mg 2- aggression/agitatio
weekly n or mood
Max.400mg elevation
weekly
Fluphenazine Gluteal Test 12.5mg 1-3 ¼-2 6-12 Less sedating,
decanoate Maintenance less hypotensive,
12.5-100mg more EPSE
2-5-weekly
Max. 50mg
weekly.
5.5 Monitoring
All antipsychotics should be monitored for efficacy and side effects including
metabolic side-effects. They should be done more frequently initially, at changes, and
if the patient is unwell.
http://intranep/TeamCentre/pharm/PublishedDocuments/nepft-antipsychotic-long-acting-injections-guidance-120306-2.doc
CG/Antipsychotic LAI/03/15 Implementation Date: March 2015 Review Date: March 2018
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5.6 Prescribing high cost injections
Risperidone consta injection and Paliperidone injection are both high-cost medicines.
They must be initiated by a consultant in mental health, and will continue to be
prescribed and monitored by NEP until the dose is stabilised (about 3 months)
It is recommended that Paliperidone be used in preference to Risperidone consta
because it has a number of practical advantages. The cost is slightly higher, but this
is outweighed by increased concordance and decreased requirement for nursing
input. Details are included in appendix 1 and 2.
Both preparations are NOT recommended for treatment-resistant schizophrenia as
they have been found to be ineffective for many of those patients.
Aripiprazole Maintena and Olanzapine LAIare both non-formulary at NEP and if a
client requires these treatments, there must be prior approval from the MMG via the
Form B Process.
7 SUMMARY OF CHANGES
Section
Date Summary of Changes
Number(s)
Formatting, grammatical changes. Links updated and
throughout
added in where appropriate. Logos updated.
Information on Aripiprazole Maintena and Olanzapine
5.3, 5.6 Depot added in. Piportil removed as discontinued. Flow
chart modified to include olanzapine and aripiprazole
February
Appendix 3
2015 Removed as costing information goes out of date quickly
and
and can be easily found elsewhere if required.
section 5
Appendix 1
To be reviewed – useful or just refer to SPC?
&2
6 References and bibliography updated.
http://intranep/TeamCentre/pharm/PublishedDocuments/nepft-antipsychotic-long-acting-injections-guidance-120306-2.doc
CG/Antipsychotic LAI/03/15 Implementation Date: March 2015 Review Date: March 2018
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