Understanding Injection Options for Schizophrenia Treatment

LAIs for schizophrenia are injected by a healthcare professional. This medication only requires doses every few weeks or even longer, and it dispenses in your body over time. This gives you a constant release of medication without having to take it orally every day.

LAIs may help you adhere to a medication regimen for schizophrenia. Some studies say that 40 percent or more of people with schizophrenia have difficulty adhering to a medication schedule.

A recent study of 75,274 people with schizophrenia found that LAIs can reduce their hospital readmission by 20 to 30 percent, compared with those taking oral medications.

First- and second-generation LAIs

There are first- and second-generation LAIs available. First-generation LAIs were developed in the 1960s, while second-generation LAIs are more recent, with most developed in the early 2000s.

Your body may tolerate second-generation LAIs better than those developed in earlier decades. Additionally, they may have fewer side effects than those first-generation medications.

Second-generation LAIs include:

• risperidone (Risperdal Consta, Perseris)
• olanzapine (Zyprexa)
• paliperidone (Invega Sustenna, Invega Trinza)
• aripiprazole (Abilify Maintena, Aristada)

Some first-generation LAIs include:

• haloperidol decanoate (Haldol)
• fluphenazine enanthate and decanoate (Prolixin)

Historically, attitudes toward LAIs have been mixed. LAIs are more frequently used as a second-line treatment for those with ongoing symptoms instead of as the first option for newly diagnosed patients.

However, a 2013 review found that LAIs may be effective and beneficial for those experiencing their first episode of schizophrenia. But more research is needed.

The medication in many LAIs is also available in oral form. Instead of a daily pill, LAIs slowly release medication into the bloodstream. When these medications are manufactured as injectables, they’re mixed with a liquid solution like water.

A healthcare professional will inject the medication into one of your muscles. The LAI will dispense in your body over time. This medication will remain in your body longer than medications taken orally.

A healthcare professional will administer injections on a regular schedule. Generally, they’ll administer the LAI in your gluteal muscle, or buttocks.

The amount of time between your injections can depend on the medication used and your prescribed dosage. Here’s the typical administration timeframe for several LAIs, depending on the brand used:

• Aripiprazole (Abilify Maintena, Aristada): every 4 to 8 weeks (Abilify Maintena); every 4, 6, or 8 weeks (Aristada)
• Fluphenazine enanthate and decanoate (Prolixin): every 1 to 4 weeks
• Haloperidol decanoate (Haldol): every 4 weeks
• Olanzapine (Zyprexa): every 2 to 4 weeks
• Paliperidone (Invega Sustenna, Invega Trinza): every 4 weeks (Invega Sustenna) or every 12 weeks (Invega Trinza)
• Risperidone (Consta, Perseris): every 2 weeks (Risperdal Consta) or every 4 weeks (Perseris)

Your doctor may prescribe oral medications to take when you start LAIs, as it can take a few weeks or months for the LAIs to work effectively in your body.

Some benefits of LAIs include:

• not needing to take and remember to take daily medication
• stability of the medication in your blood levels
• fewer risks of relapse from difficulty adhering to medication
• reduced risks of overdosing on medication
• easier absorption by the gastrointestinal system

Another benefit of receiving LAIs is that you see your doctor or someone in their office regularly for the administration of the medication. During this time, you can ask any questions and your doctor can make sure the medication is working as intended.

There can be some downsides and risks of receiving LAIs. These can depend on the type of medication you take.

First-generation LAIs have more severe side effects, including tardive dyskinesia, which can cause involuntary muscle movements. You may also feel lethargic and tired, as well as experience some weight gain.

Second-generation LAIs have fewer side effects. However, you may notice weight gain, experience changes to your metabolism, and have an increased risk of high cholesterol and diabetes, among other side effects.

Your doctor can recommend ways to counteract these side effects. This may include lifestyle changes, including exercise and dietary changes.

With most medications for schizophrenia, you should avoid drinking alcohol or using substances.

Discuss the potential side effects of these medications with your doctor. Each LAI has unique side effects and may not be a good fit for you based on your health factors.

Some other challenges of LAIs include:

• the longer length of time it takes for the medication to work, compared with oral medications
• pain and irritation at the injection site
• the requirement to visit your doctor for regular injections
• concerns about injection medication generally

If you have schizophrenia, you’ll likely talk with a doctor regularly. During this time, you can discuss the best medication options for your treatment plan. Other aspects of treatment may include psychotherapy and support groups.

You may want to discuss the option of LAIs with your doctor, whether you want to avoid taking daily oral medications, have difficulty adhering to oral medications, or continue to experience symptoms.

LAIs are one type of medication used to treat schizophrenia. They may be beneficial if it’s difficult to remember to take or adhere to oral medications.

LAIs have been in use since the 1960s, though newer forms developed in the early 2000s have fewer side effects. Your doctor may recommend LAIs to stabilize your treatment for schizophrenia, to improve symptoms, and to avoid potential hospital readmissions.