Long-Acting Injectable Antipsychotic (LAI) Medication Comparisons
| Long-Acting Injectable Antipsychotic | Antipsychotic Class | Delivery | Prerequisite to Delivery | Dosing Interval Method | Requires Oral Supplement after Initial Injection | Requires Loading Dose | Notable Side Effects | Notable Properties |
|---|---|---|---|---|---|---|---|---|
| Fluphenazine decanoate | 1st generation | IM or SQ | Establish tolerability with any shorter-acting form of fluphenazine | Up to 6 weeks (individualized for each patient) | No | No | Weight gain, metabolic syndrome, EPS,c tardive dyskinesia, QT prolongation | Low monetary cost; highest risk of EPS, tardive dyskinesia (irreversible; risk increases with increased treatment duration and dose; much less common in short treatment periods) |
| Haloperidol decanoate | 1st generation | IM | Establish tolerability with any shorter-acting form of haloperidol | 4 weeks | No | No | Weight gain, metabolic syndrome, EPS,c tardive dyskinesia, QT prolongation | Low monetary cost; highest risk of EPS, tardive dyskinesia (irreversible; risk increases with increased treatment duration and dose; much less common in short treatment periods) |
| Olanzapine pamoate (Zyprexa Relprevv®) | 2nd generation | IM | Establish tolerability with oral olanzapine | 2 or 4 weeks | No | No | Post-injection syndrome,d weight gain, metabolic syndrome | Risk of post-injection syndrome |
| Risperidone microspheres (Risperdal Consta®) | 2nd generation | IM | Establish tolerability with oral risperidone | 2 weeks | Yes, 3 weeks | No | Hyperprolactinemia, galactorrhea, weight gain, sometimes EPS | Shortest-acting injectable antipsychotic on this list |
| Paliperidoneb palmitate (Invega Sustenna®) | 2nd generation | IM | Establish tolerability with oral risperidone, oral paliperidone, or injectable risperidone | 4 weeks | No | Yes | Hyperprolactinemia, galactorrhea, weight gain, sometimes EPS | Requires loading dose, but can be administered monthly after second injection |
| Paliperidoneb palmitate (Invega Trinza®) | 2nd generation | IM | Establish tolerability with Invega Sustenna® paliperidone palmitate (at least 4-month trial) | 3 months | No | No | Hyperprolactinemia, galactorrhea, weight gain, sometimes EPS | Requires 4-month trial of tolerability with Invega Sustenna® prior to initiation of this longer-acting injectable antipsychotic |
| Risperidone RBP-7000 (Perseris®) | 2nd generation | SQ | Establish tolerability with oral risperidone | 4 weeks | No | No | Hyperprolactinemia, galactorrhea, weight gain, sometimes EPS | Does not require oral supplementation or loading dose |
| Aripiprazole monohydrate (Abilify Maintena®) | 2nd generation | IM | Establish tolerability with oral aripiprazole | 4 weeks | Yes, 2 weeks | No | Akathisia | Requires 2 weeks of concomitant administration of oral medication after initial injection |
| Aripiprazole lauroxil (Aristada®) | 2nd generation | IM | Establish tolerability with oral aripiprazole | 4, 6, or 8 weeks (depending on dose) | Yes, 3 weeks | No | Akathisia | Requires 3 weeks of concomitant administration of oral medication after initial injection |
All above information obtained from each medication’s respective prescribing information/package insert.
aIM = intramuscular; SQ = subcutaneous.
bpaliperidone is the active metabolite of risperidone.
↵cEPS (extrapyramidal side effects) include: dystonia, akathisia, parkinsonism, tardive akathisia, tardive dyskinesia; risk is higher with FGAs than with SGAs.
↵dPost-injection syndrome refers to the combination of symptoms consistent with olanzapine overdose and may include severe sedation or delirium. Patients who receive olanzapine pamoate must be monitored for 3 hours after injection by a healthcare professional.