NAPLEX Question of the Week: Long-acting antipsychotic injectables

Psychiatric pharmacotherapy is the topic of our question of the week!

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Which of the following are correct statements regarding antipsychotic LAIs (Long acting Injectable)? 

A. Abilify Maintena and Risperdal Consta requires a PO overlap for two weeks and three weeks, respectively.  

B. Risperdal Consta would be best for a patient who is only available once a month to receive his injection. 

C. Zyprexa Relprevv and Invega Sustenna require initiation dose. 

D. Haldol Decanoate requires refrigeration.

E. All LAI have a boxed warning for Increased mortality in elderly with dementia-related psychosis.


Answer with rationale:

Answers A, C, and E are correct. 

Abilify Maintena and Risperdal Consta are the only two LAI that must have a PO overlap. PO overlap can be avoided in others such as Aristada (aripiprazole lauroxil), Prolixin Decanoate and Haldol Decanoate by administering a loading dose or initiation dose. All LAI have a boxed warning for increased mortality in dementia psychosis, with Zyprexa Relprevv carrying an additional warning for Post-injection delirium/sedation syndrome. Risperdal Consta must be administered every two weeks making it the shortest LAI (answer B is incorrect), whereas Invega Trinza has the longest duration and is administer every three months. All LAI are stored at room temperature except for Risperdal Consta and Perseris which are refrigerated and only last seven days at room temperature, making answer D incorrect. 

The NAPLEX competency statements contained within this question are the following:

2.3 Boxed warnings or REMS

3.4 Drug dosing or dosing adjustments; duration of therapy
3.5 Drug route of administration, dosage forms, or delivery systems
5.6 Packaging, storage, handling, or disposal

See everyone next week!

Dr. B

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.