Optimizing Management of Schizophrenia with Long-acting Injectables - Episode 6

Administration of Available Long Acting Injectables for Schizophrenia

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Kimberly Garcia, DNP, CRNP, and Sanjai Rao, MD, DFAPA, review the administration frequencies of long acting injectables risperidone, aripiprazole, and paliperidone.

Sanjai Rao, MD, DFAPA: It’s a great segue into talking about what’s available to our patients. It’s been gratifying for me because when you and I started doing this, all we had available were a couple of first generations and maybe the earliest of the second generations.

Kimberly Garcia, DNP, CRNP: Yes.

Sanjai Rao, MD, DFAPA: Now we’ve got so many options. We’ve got multiple versions of risperidone. We’ve got the 2-week version and now a monthly subcutaneous version. We’ve got aripiprazole, which you can give every month, every 6 weeks, every 2 months.

Kimberly Garcia, DNP, CRNP: Yes.

Sanjai Rao, MD, DFAPA: Then we’ve got paliperidone, which until recently with monthly and every 3 months, but now it’s every 6 months.

Kimberly Garcia, DNP, CRNP: Every 6 months, I know. I have so many patients who were absolutely counting down the days till that happened. That was something we’d been working toward for the right patient, so to see that—when we think about their goals and what they would like to do, it’s interesting. You mentioned going from 1-month to 3-month doses.

I use a great deal of Invega products for my patients with schizophrenia. My patients were on an every-28-day regimen, and I was comfortable with that because I felt that if I was to expand the duration between injections, perhaps they would be lost to follow-up, would feel that they were cured, and would not come back for their next injection. So I was very hesitant. I was not an early adopter of switching patients from the 1-month to the 3-month product. Some of that was because I did not have as much confidence in them as I should have.

Fast-forward to the middle of the pandemic, and I have patients who were coming to the alleyway in the back of the office. We were giving injections in an alley in a dark parking lot. It’s dark out. I’m using my cell phone light to illuminate the arm so I can give the injection. We had people actively with COVID-19 coming to the parking lot to give them their injections. I say to myself, “What am I doing? Why am I doing this when I have a viable option?” It felt like it was inappropriate for me to not at least broach the conversation. I had some patients who said, “No, I’m doing fine on my once a month. I’m not going to switch.” I respect that, absolutely, because they have to have comfort.

That’s the time when I started switching my patients to the every-3-month product. What was so strange about that in its own way was they didn’t stop coming to see me. They’d still be able to see me every month. They were very consistent with their appointment, their symptoms were very well managed, and yet we’re able to use some of that time that we didn’t usually have available because it was very focused on the mechanics of the injection. Now we’re like, “Let’s talk about metabolic screening. Let’s talk about your diet and exercise patterns and look at your cholesterol and all that stuff.”

I definitely realize that those issues were mine, and I believe I held back some of my patients. COVID-19 made that very evident to me. It’s been amazing. I’ll tell you what’s so interesting: patients will come in and out of treatment, especially those on oral products. My patients who are on injectables—and I’m not saying 1 particular type of injectable, I’m talking about across the board—are some of my absolute most consistent patients.

Transcript edited for clarity.