NYMC Faculty Publications

Choosing Among the Long-Acting Injectable Antipsychotics: An Evidence-Based Pragmatic Guide

DOI

10.1017/S1092852925100400

Journal Title

Cns Spectrums

Document Type

Article

Publication Date

7-18-2025

Department

Psychiatry and Behavioral Sciences

Keywords

aripiprazole, bipolar disorder, Depot, long-acting injectable antipsychotic, olanzapine, paliperidone, risperidone, schizoaffective disorder, schizophrenia

Disciplines

Medicine and Health Sciences

Abstract

In this review, the aim is to differentiate between the 3 second-generation antipsychotics available as long-acting injectables (risperidone/paliperidone, aripiprazole, and olanzapine) and their varied formulations. Differences and similarities among the available products are discussed, including the amenities of care: route of administration (intramuscular or subcutaneous), injection frequency, needle gauge and length, injection volume, injection site, reconstitution procedures, initiation with oral medication or multiple injections, refrigeration requirements, post-injection observation requirements, drug–drug interactions preventing use or requiring dosing adjustments, adjustments requirements for late or missed doses, availability of patient assistance programs, and access barriers for off-label use. Effectiveness in acute and maintenance treatment are reviewed using the metrics of number needed to treat and number needed to harm.

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