Long-Acting Injectable Antipsychotics for Schizophrenia: What to Know

Finding the right treatment plan for schizophrenia can take time and patience. Long-acting injectable (LAI) antipsychotic medications are a treatment option that doesn’t require taking a pill every day. LAI formulations slowly release into your body, so you need them less often than medications you take by mouth. LAIs may be a helpful choice for people who have trouble following their treatment plan.

Switching your schizophrenia medication to an LAI antipsychotic is a big decision. It’s important to think about your needs and treatment goals. Keep reading to learn more about LAI medications so you can see if they might be a good fit for your care plan.

What Are Long-Acting Injectable Antipsychotics?

Long-acting injectable antipsychotics are given as an injection. LAIs are also known as depot antipsychotics because the medicine stays stored in your body and slowly releases over a few weeks or months.

LAI antipsychotic drugs work similarly to antipsychotic oral formulations (taken by mouth). LAI formulations treat symptoms of psychosis — such as hallucinations (seeing or hearing things that aren’t there) and delusions (strong false beliefs) — in people with schizophrenia or other mental health problems, like schizoaffective disorder and bipolar disorder.

Not every antipsychotic comes as an LAI, but several first-generation (older) and second-generation (newer) antipsychotics are available in this form. These include:

• Aripiprazole lauroxil (Aristada, Aristada Initio)
• Aripiprazole monohydrate (Abilify Asimtufii, Abilify Maintena)
• Fluphenazine decanoate
• Haloperidol decanoate (Haldol Decanoate)
• Olanzapine pamoate (Zyprexa Relprevv)
• Paliperidone palmitate (Erzofri, Invega Hafyera, Invega Sustenna, Invega Trinza)
• Risperidone microspheres (Risperdal Consta, Rykindo)
• Risperidone polymer (Perseris, Uzedy)

How often you get these injections depends on the type of medication. Some are given once every two weeks, whereas others — like Invega Hafyera — are received just once every six months. Most LAI antipsychotics are given about once a month.

How Do Long-Acting Injectable Antipsychotics Differ From Other Schizophrenia Medications?

Most schizophrenia medications come as pills that you swallow. When you take a pill, the medication gets absorbed into your bloodstream through your stomach or intestines. LAI antipsychotics are injected into a muscle or just beneath the skin.

In LAI antipsychotics, the medicine is mixed with an oil or water base that helps it release slowly into your body over time. Research shows that LAIs work at least as well as oral antipsychotics for treating episodes of psychosis and for maintenance treatment (regular, ongoing treatment) of schizophrenia.

You might notice that a single dose of an LAI antipsychotic drug is higher than one pill of the same medicine. That’s because an injection is meant to last for weeks or months, unlike pills that last for just a few hours or days.

Who Might Benefit From Long-Acting Injectable Antipsychotics?

LAI antipsychotics aren’t just for people who can’t make treatment decisions. Although some people may receive LAI antipsychotics when they’re in the hospital or too unwell to manage their care, these medications can be a helpful treatment option for anyone taking antipsychotics regularly as part of their schizophrenia treatment. Your healthcare provider may suggest switching to an LAI if you’re already doing well on the same oral medication and need to take it long term.

You receive an LAI just every few weeks or months, so you don’t have to remember to take a pill every day. You might prefer this type of treatment if you have trouble:

• Sticking to a treatment plan
• Remembering a daily medication
• Swallowing pills

LAI antipsychotics generally have side effects similar to pill forms. In some cases, the medication side effects of LAIs may occur less often. For example, one study showed that people taking olanzapine as an LAI were less likely to experience weight gain, drowsiness, or dry mouth compared to those on the pill version.

LAI antipsychotic medications can make it easier to stick to your treatment plan. When you take your antipsychotic medication as prescribed, you’re less likely to experience an episode of psychosis or feel unwell.

What Are the Drawbacks of Long-Acting Injectable Antipsychotics?

Like any treatment, LAI antipsychotics have both benefits and drawbacks. Some people feel they have less control over their treatment when taking LAIs because they’re scheduled for every few weeks or months, leaving less flexibility. If you develop side effects, they may take longer to go away once you stop the medication.

Some people find injections uncomfortable or stressful, especially if they don’t like needles or have had past unpleasant experiences. You might have mild pain or swelling at the injection site for a few days after getting the injection. Alternating injection sites each time can help avoid those types of problems.

Most people become more comfortable with injections over time. Your healthcare provider can suggest ways to make the process less stressful for you.

Keep in mind that because a healthcare provider has to deliver the injection, you’ll need to travel to the clinic. If arranging transportation is hard for you, talk with your doctor about possible solutions.

What Should You Expect When Starting a Long-Acting Injectable Antipsychotic?

When starting a new antipsychotic medication, you may first receive an oral form or a shorter-acting injectable form. This test dose helps check if you’ll have any serious side effects before starting the long-acting versions.

Most LAI antipsychotics are injected into a large muscle, such as your upper arm or buttocks. Some are injected just beneath the skin in places like your stomach or the back of an arm.

You might get your injections at your healthcare provider’s office or a community mental health center. Some types require monitoring for a short time after the injection.

Because LAI medications release slowly, they can take longer to work compared to pills. Your healthcare provider may have you keep taking your usual oral antipsychotic until the LAI fully kicks in. If you’re already on antipsychotic medication, you’ll likely continue taking it for a short time.

Talk to Your Healthcare Team About Your Treatment Plan

The decision to start taking an LAI depends on many factors. What works well for someone else might not be right for you. LAI antipsychotics can help many people, but they’re just one among several treatment options. The best treatment plan is the one that supports your needs, preferences, and goals.

Researchers are still learning about the long-term risks and benefits of LAI antipsychotics. If you’re thinking about trying one, talk with your healthcare team. They can help you weigh the pros and cons and find the treatment plan that works best for you.

Find Your Team

On MySchizophreniaTeam, the site for people living with schizophrenia and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with schizophrenia.

Have you or your loved one taken a long-acting injectable antipsychotic medication? What advice do you have for others thinking about taking a long-acting injectable antipsychotic? Share your experience in the comments below.