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Clinical Pearls
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An initial episode of psychosis heightens the risk of future relapses by causing brain tissue damage (12, 13).
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Early intervention with LAIs can halt neurodegeneration, stabilize symptoms, and protect brain function (13–15). These advantages may result from enhanced adherence and favorable pharmacokinetic properties (14).
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LAIs are suitable as an initial treatment option and should be presented to all patients diagnosed with schizophrenia, not just those with severe symptoms or adherence challenges (3,6,7,14,16).
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FDA-approved for use across the illness spectrum, LAIs provide consistent symptom control and significantly lower relapse risk in both first-episode and chronic schizophrenia (9,17).
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Practical Tips
Introduce LAI Options Early: Proactively discuss LAIs with all patients early in the treatment journey to highlight their potential benefits and ensure shared decision-making (2,7).
Engage Caregivers: Actively involve caregivers in treatment discussions to align care plans with the needs, values, and goals of both patients and their support systems (24).
Consider Emerging LAI Options: Stay informed about new and innovative LAI formulations to expand treatment choices and improve outcomes for diverse patient needs (14,25).
Advantages of LAIs Over Oral Antipsychotics:
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Reliable Delivery: Bypass the deactivating process that oral antipsychotics undergo in the liver, leading to predictable plasma drug concentrations, a greater amount of the drug reaching the brain, and minimized drug interactions (16,18,19).
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Enhanced Adherence: Eliminate the need for daily dosing, improve adherence, and reduce relapse and hospitalization rates (20).
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Side Effect Profile: Certain side effects occur less frequently with LAIs compared to their oral counterparts (3,19,21,22).
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Novel and emerging LAI formulations offer advantages to patients and clinicians.
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Currently, one new formulation is undergoing phase 3 trials: an olanzapine LAI (23).
