LAI Explorer

This tool is designed to provide knowledge for utilization of a long-acting injectable (LAI) medication based upon the selection by the provider. The filters on the left side of the tool provide the opportunity to select characteristics of the available LAI medications to review available LAIs which meet those criteria.

 

Oral tolerability with all medications should be verified prior to consideration of a long-acting injectable antipsychotic medication.

Showing All Results
Indication(s)
Generic Drug Name
Maintenance Injection Site(s)
Maintenance Injection Interval
Storage
Oral Overlap
Loading Dose
Reconstitution
REMS

Abilify Asimtufii

Abilify Asimtufii

Indication(s):
Bipolar I Maintenance
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 8 Weeks
Storage:
Room Temperature
Oral Overlap:
Varied Requirements
Loading Dose:
Not Established
Reconstitution:
No
REMS:
No
Generic Drug Name:
Aripiprazole

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla.

Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Abilify Maintena

Abilify Maintena

Indication(s):
Bipolar I Maintenance
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 4 Weeks
Storage:
Room Temperature
Oral Overlap:
Required
Loading Dose:
Not Established
Reconstitution:
Yes
REMS:
No
Generic Drug Name:
Aripiprazole

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla.

Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Aristada

Aristada

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle (441 mg dose only)
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 4 Weeks
Every 6 Weeks
Every 8 Weeks
Storage:
Room Temperature
Oral Overlap:
Varied Requirements
Loading Dose:
Required
Reconstitution:
No
REMS:
No
Generic Drug Name:
Aripiprazole

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla.

Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Fluphenazine Decanoate

Fluphenazine Decanoate

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 2 Weeks
Every 4 Weeks
Storage:
Room Temperature
Oral Overlap:
Required
Loading Dose:
Not Established
Reconstitution:
No
REMS:
No
Generic Drug Name:
Fluphenazine

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla.

Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Haloperidol Decanoate

Haloperidol Decanoate

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 4 Weeks
Storage:
Room Temperature
Oral Overlap:
Required
Loading Dose:
Required
Reconstitution:
No
REMS:
No
Generic Drug Name:
Haloperidol

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla.

Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Invega Hafyera

Invega Hafyera

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 6 Months
Storage:
Room Temperature
Oral Overlap:
Not Required
Loading Dose:
Varied Requirements
Reconstitution:
No
REMS:
No
Generic Drug Name:
Paliperidone

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla.

Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Invega Sustenna

Invega Sustenna

Indication(s):
Schizoaffective Disorder
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 4 Weeks
Storage:
Room Temperature
Oral Overlap:
Not Required
Loading Dose:
Required
Reconstitution:
No
REMS:
No
Generic Drug Name:
Paliperidone

Invega Sustenna (“Sustenna” or paliperidone palmitate) is a long-acting injectable (LAI) formulation of paliperidone. It was the first available second-generation antipsychotic LAI to provides coverage for 4 weeks. It is FDA-indicated to treat adults with diagnoses of schizophrenia and schizoaffective disorder.

Invega Sustenna

Indication(s)

Schizophrenia; Schizoaffective Disorder

Dosing available as prefilled syringes

39 (injection volume of 0.25 ml) corresponds to a daily oral dose of paliperidone 3 mg
78 mg (injection volume of 0.5 ml) corresponds to a daily oral dose of paliperidone 3 mg
117 mg (injection volume of 0.75 ml) corresponds to a daily oral dose of paliperidone 6 mg
156 mg (injection volume of 1 ml) corresponds to a daily oral dose of paliperidone 9 mg
234 mg (injection volume of 1.5 ml) corresponds to a daily oral dose of paliperidone 12 mg

Recommended starting and maintenance dose

Recommended maintenance dose for treatment of schizophrenia is 117 mg.

Drug Metabolizing Enzyme

CYP3A4

Dosing exclusions

CrCL dosing:
For patients with mild renal impairment (CrCl >/= 50 mL/min to < 80 mL/min: Initiate Sustenna with a dose of 156 mg on treatment day 1, 117 mg one week later. Monthly maintenance dose of 78 mg ; adjust monthly maintenance dose based on tolerability and/or efficacy
Not recommended in patients with moderate or severe renal impairment (CrCl < 50 mL/min

Loading dose

Loading dose strategy is recommended after tolerability has been established with oral risperidone or paliperidone (for patients naïve to Invega Sustenna):On day 1 administer Invega Sustenna 234 mg in the deltoid.
One week later administer Invega Sustenna 156 mg in the deltoid per medication label, while using clinical judgment. (Published data suggests Invega Sustenna 234 mg for both initiation doses and maintenance is safe.)
Seven days is recommended for the second loading dose, but a window of 4-10 days is acceptable.
The first maintenance dose should be administered 5 weeks following the first (of 2) loading doses.Maintenance dose should be selected to correspond with appropriate oral dose equivalent (as detailed above).
The loading dose strategy should NOT be used for patients switching from one LAI to another, i.e., Aristada to Invega Sustenna. Detailed protocols for switching between LAIs have not been established, but it is recommended that there is overlap of 1-3 weeks when switching to oral paliperidone. Therefore, prescribers should stop the previous LAI and initiate the new LAI at targeted maintenance dose when possible.

Oral overlap

No oral supplementation is necessary.

Establishing tolerability

Prior to initiating Invega Sustenna, establish tolerability with oral paliperidone or risperidone.

Storage

Room temperature

Reconstitution or mixing

N/A

Injection site

Choose between the deltoid or gluteal muscle (for maintenance doses) based on the patient preference and body habitus. Both loading doses should be administered in the deltoid muscle.Rotate injection sites to avoid muscle hypertrophy, abscesses, and tissue damage by repeated, frequent injections at the same site.
For deltoid injections: For patients weighing less than 90 kg, the 1-inch, 23 gauge needle is recommended.
For patients weighing 90 kg or more, the 1 ½-inch, 22 gauge needle is recommended.
For gluteal injections:The recommended needle size for administration of Invega Sustenna into the gluteal muscle is the 1½-inch, 22 gauge needle regardless of patient weight.
Deltoid is specifically recommended for faster distribution during the initiation phase.

Injection interval

Every 4 weeks

Preparation

Shake the syringe vigorously for a minimum of 10 seconds to ensure a homogeneous suspension. Priming the syringe is recommended.

Administration considerations

Administer the injection within 5 minutes of shaking. Inject the entire contents intramuscularly slowly, deep into the selected deltoid or gluteal muscle of the patient.

Timing variations

For initiation dosing: the second initiation dose can be given within a 4 to 10 day window after the first injection.

To avoid a missed maintenance injection, patients may be given the injection up to 7 days before or after the monthly time point.

When a dose is missed

See this tip on how to manage missed doses of Invega Sustenna.
Monthly doses can be flexibly administered one week before or after the scheduled dose to avoid missed doses.

REMS

No

Dose Conversion of Oral Paliperidone to Paliperidone Palmitate LAI

PO Dose 

LAI/IM Dose

Initiate LAI doses

Loading doses – 234 mg day 1, followed by 156 mg day 8, followed by maintenance dose 5 weeks after first injection

3 mg paliperidone

39-78 mg Invega Sustenna every 4 weeks

3 mg paliperidone

78 mg Invega Sustenna every 4 weeks

6 mg paliperidone

117 mg Invega Sustenna every 4 weeks

9 mg paliperidone

156 mg Invega Sustenna every 4 weeks

12 mg paliperidone

234 mg Invega Sustenna every 4 weeks

Recommended available dose formulations include 39 mg, 78 mg, 117 mg, 156 mg, and 234 mg pre-filled syringes.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841
3. INVEGA SUSTENNA USPI, Section 2.1 Administration Instructions; Section 2.2: Schizophrenia and Schizoaffective Disorder; Section 2.6: Switching from Other Antipsychotics; Section 17: How Supplied/Storage and Handling 

FDA medication label

  • Information on this topic is found in the FDA medication label. Here is the most recent label, at time of writing.
  • Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices. Labels change over time, and the current label should always be consulted.
If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!

Invega Trinza

Invega Trinza

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 3 Months
Storage:
Room Temperature
Oral Overlap:
Not Required
Loading Dose:
Varied Requirements
Reconstitution:
No
REMS:
No
Generic Drug Name:
Paliperidone

Invega Trinza is a long-acting injectable (LAI) formulation of paliperidone. It is the first available antipsychotic LAI available that provides coverage for 12 weeks. It is FDA-indicated to treat adults with schizophrenia.

Invega Trinza

Indication(s)

Schizophrenia

Dosing available as prefilled syringes

273 mg (injection volume of 0.875 ml) 
410 mg (injection volume of 1.315 ml)
546 mg (injection volume of 1.75 ml)
819 mg (injection volume of 2.625 ml)

Recommended starting and maintenance dose

Used only after establishment of four months of Invega Sustenna once monthly injection (last 2 months with the same dose); dose based on Invega Sustenna IM once monthly dose

Drug Metabolizing Enzyme

CYP3A4

Dosing exclusions

Invega Trinza is not recommended in patients with moderate or severe renal impairment

Loading dose

Dose equivalence to Sustenna:
39 mg Invega Sustenna to N/A for Trinza
78 mg of Invega Sustenna to 273 mg for Trinza
117 mg Invega Sustenna to 410 mg Trinza
156 mg Sustenna to 546 mg Trinza
234 mg Sustenna to 819 Trinza

Oral overlap

None required.

Establishing tolerability

Prior to initiating Invega Trinza, treat the patient with Invega Sustenna (1 month formulation of paliperidone palmitate) for at least 4 months to ensure optimal dosing. In order to establish a consistent maintenance dose, it is recommended that the last two doses of Invega Sustenna be the same dosage strength before starting Invega Trinza.

Storage

Room temperature

Reconstitution or mixing

No reconstitution required
See Invega Sustenna for any changes

Injection site

Choose between the deltoid or gluteal muscle based on the patient preference and body habitus. Rotate injection sites to avoid muscle hypertrophy, abscesses, and tissue damage by repeated, frequent injections at the same site.

Injection interval

Every 12 weeks

Preparation

With the syringe tip pointing up, shake vigorously with a loose wrist for at least 15 seconds to ensure a homogeneous suspension. If more than 5 minutes pass before injection, shake vigorously, with the syringe tip pointing up, again for at least 15 second to re-suspend the medication. Priming the syringe is recommended.

Administration considerations

Inject the entire contents intramuscularly slowly, deep into the selected deltoid or gluteal muscle of the patient.
The thin-walled needles included in the Invega Trinza kit must be used for the injection.

Timing variations

To avoid a missing dose: patients may be given the injection up to 2 weeks before or after the 3-month time point.

When a dose is missed

If a patient has missed a dose and it is 3.5 months to 4 months since last injection: the previously administered Trinza dose should be administered as soon as possible, then continue with the 3-month injections following the dose.

If 4 months to 9 months since last injection: This requires re-initiation via table 2 in the package insert.

REMS

No

 

Dose Conversion of Oral Paliperidone to Paliperidone Palmitate 12-week LAI

PO Dose 

LAI/Invega Sustenna Dose **Stabilization with Invega Sustenna required prior to initiation of Invega Trinza

LAI/Invega Trinza Dose

< 3 mg paliperidone

39 mg Invega Sustenna every 4 weeks

N/A

3 mg paliperidone

78 mg Invega Sustenna every 4 weeks

273 mg Invega Trinza every 12 weeks

6 mg paliperidone

117 mg Invega Sustenna every 4 weeks

410 mg Invega Trinza every 12 weeks

9 mg paliperidone

156 mg Invega Sustenna every 4 weeks

546 mg Invega Trinza every 12 weeks

12 mg paliperidone

234 mg Invega Sustenna every 4 weeks

819 mg Invega Trinza every 12 weeks

Recommended available dose formulations include 273 mg, 410 mg, 546 mg, and 819 mg pre-filled syringes.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841
3. INVEGA SUSTENNA USPI, Section 2.8: Instructions for Use; Section 17: How Supplied/Storage and Handling 

FDA Medication Label

Information on this topic is found in the FDA medication label.  Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.

Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.

Administraion/Dosing Guide

More information about administration (including a detailed video) and dosing can be found here.

 

REFERENCES

  • INVEGA SUSTENNA USPI, Section 1: Indications and Usage
If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!

Perseris

Perseris

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Subcutaneously Back of the Upper Arm
Subcutaneously in the Abdomen
Maintenance Injection Interval:
Every 4 Weeks
Storage:
Refrigerator
Oral Overlap:
Not Required
Loading Dose:
Not Established
Reconstitution:
Yes
REMS:
No
Generic Drug Name:
Risperidone

Perseris is a long-acting injectable (LAI) formulation of risperidone. It is the first available antipsychotic LAI available which is administered subcutaneously (rather than intramuscularly). Subcutaneous injections are given under the skin using shorter and smaller gauge needles. Intramuscular injections are given deeper into muscular tissue using longer and larger gauge needles. Perseris is FDA-indicated to treat adults with schizophrenia.

Perseris

Indication(s)

Schizophrenia

Dosing available as prefilled syringes

Available in 90 mg or 120 mg kits:
4 mg oral risperidone corresponds to 120 mg (injection volume of 0.8 ml) Perseris
3 mg oral risperidone corresponds to 90 mg (injection volume of 0.6 ml) Perseris 

Recommended starting and maintenance dose

Based on the oral dose of risperidone 

Drug Metabolizing Enzyme

CYP2D6, CYP3A4

Dosing exclusions

In patients with renal or hepatic impairment, titrate with oral risperidone up to at least 3 mg daily. 

Loading dose

No loading dose recommended


Oral overlap

No oral supplementation recommended

Establishing tolerability

Storage

Must remain refrigerated, but can remain at room temperature for up to 7 days.
Should be brought to room temperature for at least 15 minutes prior to mixing.

Reconstitution or mixing

Should be brought to room temperature for at least 15 minutes prior to mixing. Mixing requires at least 60 cycles between liquid and powder syringes.

Injection site

Subcutaneous abdominal or back of upper arm injection

Injection interval

Every 4 weeks

Preparation

Hold the powder syringe upright and tap the barrel of the syringe to dislodge the packed powder. Remove the cap from the liquid syringe, then remove the cap from the powder syringe.  Place the liquid syringe on top of the powder syringe and connect the syringes by twisting approximately ¾ turn.  Keep your fingers off the plungers during this step to avoid spillage of the medication.  Transfer the contents of the liquid syringe into the powder syringe. Gently push the powder syringe plunger until you feel resistance.  Repeat this gently back and forth process for 5 cycles.  Continue mixing the syringes for an additional 55 cycles.  Transfer all contents into the liquid syringe.  Simultaneously maintain slight pressure on the powder syringe plunger and pull back gently on the liquid syringe plunger while twisting the syringes apart.  Attach needle and inject as directed per the package insert. Priming of the syringe is recommended.

Administration considerations

Select the injection site: subcutaneously in the abdomen or back of the upper arm.  See package insert for full details.  Pinch the skin around the injection area.  Lift the adipose tissue from the underlying muscle to prevent accidental intramuscular injection.  Insert needle fully into the subcutaneous tissue.  Inject the medication slow and steady.  Withdraw the needle at the same angle used for insertion and release pinched skin.

When a dose is missed

REMS

No

Additional information

Use of this LAI formulation of risperidone (Perseris) decreases necessary frequency of injections over original risperidone LAI (Risperdal Consta).  
Provides initial peak plasma concentration in 4 to 6 hours of both risperidone and its metabolite, yielding steady plasma levels following initial injection.
Patients who are stable on oral risperidone doses lower than 3 mg/day or higher than 4 mg/day may not be candidates for Perseris.

Dose Conversion of Oral Risperidone to Risperidone Subcutaneous LAI

PO Dose

LAI/SC Dose

3 mg daily

90 mg every 4 weeks

4 mg daily

120 mg every 4 weeks

Recommended available dose formulations include 90 mg and 120 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Indivior. (2018). Perseris dosing and administration.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

FDA Medication Label

Information on this topic is found in the FDA medication label.  Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.

Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.

Administration/Dosing Guide

More information about administration (including a detailed video) and dosing can be found here.

If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!

Risperdal Consta

Risperdal Consta

Indication(s):
Bipolar I Maintenance
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Deltoid Muscle
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 2 Weeks
Storage:
Refrigerator
Oral Overlap:
Required
Loading Dose:
Not Established
Reconstitution:
Yes
REMS:
No
Generic Drug Name:
Risperidone

Risperdal Consta was the first of the second-generation antipsychotics that became available as a long-acting injectable antipsychotic.  The efficacy and side effect profile corresponds to oral risperidone.  It is FDA-approved for the treatment of schizophrenia and for the maintenance treatment of bipolar 1 disorder.

Risperdal Consta 

Indication(s)

Schizophrenia

Dosing available as prefilled syringes

12.5 mg (2 mL)
25 mg (2 mL)
37.5 mg (2 mL)
50 mg (2 mL)

Recommended starting and maintenance dose

The recommended dose is 25 mg IM every 2 weeks.
Consta is initiated with the 25 mg dose unless clinical factors suggest to start with 12.5 mg.

Drug Metabolizing Enzyme

CYP2D6, CYP3A4

Dosing exclusions

Patients with renal or hepatic impairment should be treated with titrated doses of oral Risperdal prior to initiating treatment with Risperdal Consta.

Loading dose

No established loading-dose strategy.

Oral overlap

Initiating Consta requires overlap with oral risperidone (at a therapeutic dose) for 3 weeks.
Risperdal Consta 12.5 mg IM every two weeks corresponds to 1 mg oral risperidone per day. This means that the highest available Consta dose of 50 mg IM every two weeks corresponds to 4 mg oral per day. For many chronic patients with schizophrenia, this is at the low end of the dose range. Since Consta injections should not be combined, clinicians sometimes supplement Consta with oral risperidone if a higher dose is desired.

Establishing tolerability

Storage

Requires refrigeration

Reconstitution or mixing

Use only components of the pre-packed dose packages containing the drug and syringe prefilled with diluent. Follow instructions from package insert regarding reconstitution.

Injection site

Deltoid or gluteal injections are bioequivalent; the site can be chosen based on patient preference. Alternate sites and use 1-inch needle for deltoid, 2-inch needle for gluteal injection.

Injection interval

Every 2 weeks

Preparation

Allow product to come to room temperature for at least 30 minutes before reconstituting.  Flip the cap from the vial.  Attach the vial adapter to the vial.  Swab the syringe connection point with an alcohol pad.  Snap the white cap off the prefilled syringe.  Attach the syringe to the vial adapter.  Inject the entire contents of the syringe containing the diluent into the vial. Shake the vial vigorously while holding the plunger rod down with the thumb for a minimum of 10 seconds to ensure a homogeneous suspension.  If 2 minutes pass before injection, re-suspend by shaking vigorously.  Invert the vial completely and slowly withdraw the suspension from the vial into the syringe.  Unscrew the syringe from the vial adapter and inject per package insert instructions.  Priming of the syringe is recommended.

Administration considerations


The injection is water-based which is less painful than decanoates. You don’t need to push hard.
Always give the full vial that you selected (the microspheres are not evenly distributed in the syringe). You should also not combine different doses of Consta.

Timing variations

N/A

When a dose is missed

REMS

No

Additional information

Adjustment in dose should not be made more frequently than every 4 weeks.
This product is now available generically. 

Dose Conversion of Oral Risperidone to Risperidone Microspheres LAI

PO Dose 

LAI/IM Dose

1 mg daily

12.5 mg (injection volume of 2 ml) every 2 weeks

2 mg daily

25 mg (injection volume 2 ml) every 2 weeks

3-5 mg daily

37.5 mg (injection volume 2 ml) every 2 weeks

4-5 mg daily

50 mg (injection volume 2 ml) every 2 weeks

Recommended available dose formulations include 12.5 mg, 25 mg, 37.5 mg, and 50 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions, in patients with hepatic or renal impairment, or in patients who have a history of poor tolerability to psychotropic medications. 

References:
1. Bai, Y.M., Chen, T.T., Chen, J-Y., Chang, W-H., Wu, B., Hung, C.H., & Lin, W.K. (2007). Equivalent switching dose from oral risperidone to risperidone long-acting injection: A 48-week randomized, prospective, single-blind pharmacokinetic study. Journal of Clinical Psychiatry, 68(8), 1218-1225. doi: 10.4088/jcp.v68n0808.
2. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.
3. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841
4. RISPERDAL CONSTA USPI Section 2.1: Schizophrenia; Section 2.2: Bipolar Disorder; Section 2.3: General Dosing Information; Section 2.8: Instructions for Use

5. Taylor, D.M., Barnes, T.R.E, & Young, A.H. (2021). The Maudsley prescribing guidelines in psychiatry (14th ed.). Wiley Blackwell. 

FDA Medication Label

Information on this topic is found in the FDA medication label.  Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.

Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.

If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!

Uzedy

Uzedy

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Subcutaneously Back of the Upper Arm
Subcutaneously in the Abdomen
Maintenance Injection Interval:
Every 4 Weeks
Every 8 Weeks
Storage:
Refrigerator
Oral Overlap:
Not Required
Loading Dose:
Not Established
Reconstitution:
No
REMS:
No
Generic Drug Name:
Risperidone

Uzedy is a long-acting injectable (LAI) formulation of risperidone.  It is administered subcutaneously (rather than intramuscularly).  Subcutaneous injections are given under the skin using shorter and smaller gauge needles.  Intramuscular injections are given deeper into muscular tissue using longer and larger gauge  needles.  Uzedy is FDA-indicated to treat adults with schizophrenia.  It can be given every 4 or 8 weeks.

Uzedy 

Indication(s)

Schizophrenia

Dosing available as prefilled syringes

50 mg/0.14 mL
75 mg/0.21 mL
100 mg/0.28 mL
125 mg/0.35 mL
150 mg/0.42 mL
200 mg/0.56 mL
250 mg/0.7 mL 

Recommended starting and maintenance dose

To start: Switch from oral daily risperidone. Initiate as either once monthly injection or a once every 2 month injection, the day after the last dose of oral therapy. See table 1 in package insert to determine oral dose.

Drug Metabolizing Enzyme

CYP2D6, CYP3A4

Dosing exclusions

In patients with renal or hepatic impairment, titrate with oral risperidone (up to at least 2 mg daily) before initiating Uzedy.

Loading dose

No loading dose recommended

Oral overlap

No oral supplementation recommended

Establishing tolerability

Storage

Requires refrigeration. May store for up to 90 days in its unopened original packaging at room temperature.

Reconstitution or mixing

Doesn't require reconstitution; but mixing in terms of shaking is required

Injection site

Subcutaneously in the abdomen or back of the upper arm

Injection interval

Every 4 or 8 weeks

Preparation

Allow product to come to room temperature for at least 30 minutes.  Uzedy is a solid at refrigerated temperatures and must reach room temperature prior to administration. Flick syringe forcefully three times to move the bubble to the cap. Standing while you do this may help achieve required force.  Holding the syringe up to a light or against a dark backdrop may improve visibility. If the bubble is not at the cap, repeat the flicking until it is.  Bend and snap off the cap and attach the needle.  Do not prime the syringe.   Inject per the package insert instructions.

Administration considerations

Select the injection site: subcutaneously in the abdomen or back of the upper arm.  See package insert for full details.  Pinch at least 1 inch of the selected area.  Insert the needle into subcutaneous tissue.  Release the pinched skin once the needle is in the subcutaneous tissue.  Inject the medication- using a slow, firm, and steady push until the entire dose is delivered.  Inject the entire dose at one time, without interruption.  Resistance will be experienced during dose delivery.  Do not use excessive force in an attempt to deliver Uzedy faster.  Wait 2-3 seconds after the entire dose is delivered before removing the needle.  Slowly pull the needle out from the injection site at the same angle as insertion.

Timing variations

N/A

When a dose is missed

When a dose of Uzedy is missed, administer the next Uzedy injection as soon as possible. See this tip for more information.

REMS

No

Additional information

Patients who are stable on oral risperidone doses lower than 2 mg/day or higher than 5 mg/day may not be candidates for Uzedy.
The medication provides a quick initial release.

Dose Conversion of Oral Risperidone to Uzedy™

Oral Dose

Uzedy Dosage Once Monthly

Uzedy Dosage Once Every 2 Months

2 mg daily of risperidone

50 mg

100 mg

3 mg daily of risperidone

75 mg

150 mg

4 mg daily of risperidone

100 mg

200 mg

5 mg daily of risperidone

125 mg

250 mg

Reference: Teva Neuroscience, Inc. (2023). Uzedy prescribing information

FDA medication label

  • Information on this topic is found in the FDA medication label.
  • Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices. Labels change over time, and the current label should always be consulted.

 

If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!

Zyprexa Relprevv

Zyprexa Relprevv

Indication(s):
Schizophrenia
Maintenance Injection Site(s):
Intramuscular Gluteal Muscle
Maintenance Injection Interval:
Every 2 Weeks
Every 4 Weeks
Storage:
Room Temperature
Oral Overlap:
Not Required
Loading Dose:
Not Established
Reconstitution:
Yes
REMS:
Yes
Generic Drug Name:
Olanzapine

Zyprexa Relprevv is a long-acting injectable (LAI) formulation of Zyprexa (olanzapine). It is a second-generation antipsychotic LAI that can be administered every 2 or every 4 weeks. It is FDA-indicated for treatment of schizophrenia in adults.

Zyprexa Relprevv should not be confused with Zyprexa IntraMuscular (10 mg/vial), which is a short-acting formulation of Zyprexa.

Zyprexa Relprevv

Indication(s)

Schizophrenia

Dosing available as prefilled syringes

150 mg (1 mL)
210 mg (1.4 mL)
300 mg (2 mL)
405 mg (2.7 mL)

Recommended starting and maintenance dose

Recommended dosing for Zyprexa Relprevv is based on correspondence to oral Zyprexa doses (see table below).

Drug Metabolizing Enzyme

CYP1A2, CYP2D6 

Dosing exclusions

Requires a REMS

Loading dose

Not required

Oral overlap


Not required

Establishing tolerability

Prior to initiating Zyprexa Relprevv, establish tolerability with oral olanzapine.

Storage

Room temperature not to exceed 30°C (86°F). When the drug product is suspended in the solution for Zyprexa Relprevv, it may be held at room temperature for 24 hours.

Reconstitution or mixing

Reconstitution required

Injection site

Deep intramuscular gluteal injection using a 19-gauge, 1.5-inch needle

Injection interval

Every 2 to 4 weeks 

Preparation

Lightly tap the vial to loosen powder. Withdraw the pre-determined diluent volume into the provided syringe. Inject diluent into the powder vial. Tap the vial firmly and repeatedly on a surface until no powder is visible. Shake the vial vigorously until the suspension appears smooth. If foam forms, let vial stand to allow foam to dissipate.

Administration considerations

After insertion of the needle into the muscle, aspirate for several seconds to ensure that no blood appears. If any blood is drawn into the syringe, discard the syringe and the dose and being with a new convenience kit. The injection should be performed with steady, continuous pressure. Post injection monitoring must occur for three hours and the patient must be accompanied by someone to their destination when leaving.

Timing variations

None noted

When a dose is missed

No information provided

REMS

Yes

Additional information

Zyprexa®Relprevv™ can cause serious reactions following injection called post-injection delirium sedation syndrome. Post-Injection Delirium/Sedation Syndrome signs and symptoms are consistent with olanzapine overdose, in particular, sedation (including coma) and/or delirium. The risk of post-inection delirium sedation syndrome is present with every injection, although it is a small risk. Zyprexa® Relprevv™ must be administered in a registered healthcare facility with ready access to emergency response services. After each injection, patients must be observed at the healthcare facility by a healthcare professional for at least 3 hours. Because of this risk, Zyprexa® Relprevv™ is available only through a restricted distribution program called Zyprexa® Relprevv™ Patient Care Program and requires prescriber, healthcare facility, patient, and pharmacy enrollment. Community pharmacies are eligible for administration per the REMS criteria.

FDA medication label

  • Information on this topic is found in the FDA medication label. Here is the most recent label, at time of writing.
  • Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices. Labels change over time, and the current label should always be consulted.

 

If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!

DISCLAIMER: The LAI Explorer tool and the information it presents are intended to assist a clinician in identifying some long-acting injectable (LAI) medications which meet particular criteria designated by the clinician through filters within the tool. It does not provide a statement as to the standard of care and is not inclusive of all available medications. The filters within the tool and the summary facts about each medication do not reflect all relevant criteria or information that a clinician should consider when determining whether to prescribe an LAI and do not substitute for the independent professional judgment of the treating clinician. When considering whether to prescribe an LAI medication, the clinician should review the official product labeling information for authoritative information about the medication and should not rely on the LAI Explorer provided by SMI Adviser. Mention within the LAI Explorer of any medication should not be construed as an endorsement, advertisement or recommendation of it or any other medication. APA provides the information on this site on an “as is” basis and makes no warranty, expressed or implied, regarding it. APA assumes no responsibility for any injury or damage arising out of or related to any use of the information or any medication mentioned within the LAI Explorer.