Neuroleptics long-acting

Fluphenazine A phenothiazine neuroleptic that is often formulated as a long-acting decanoate. 

Non-motor signs of the disorder are also treatable with symptomatic medications. The frequent mood disorder can be treated with standard antidepressants, including tricyclics (such as amitryptiline) or serotonin reuptake inhibitors (SSRIs, such as fluoxetine or sertraline). This treatment is not without risks in these patients, as it may trigger manic episodes or may even precipitate suicide. Anxiety responds to benzodiazepines, as well as to effective treatment of depression. Long-acting benzodiazepines are favored over short-acting ones because of the lesser abuse potential. Some of the behavioral abnormalities may respond to treatment with the neuroleptics as well. The use of atypical neuroleptics, such as clozapine is preferred over the typical neuroleptics as they may help to control dyskinesias with relatively few extrapyramidal side-effects (Ch. 54). 

Among the difficulties in pharmacological treatment is the frequent non-compliance. The biggest determinant of compliance is the quality of a patient s relationship with his doctor. But a further way to handle the issue has involved the development of long acting products (depot neuroleptics), even though their effectiveness in the absolute or compared to oral preparations has not been adequately explored. The most commonly used depot agents are fluphenazine and haloperidol decanoate (see David et al., 2004). 

Long-acting, parenteral, antipsychotic administration remains an important option in various clinical situations. Presently, only neuroleptics are available in this formulation, but it is anticipated that depot formulations of novel antipsychotics (e.g., risperidone, olanzapine) may soon be approved. The advent of such agents should significantly improve the efficacy and safety of this strategy. 

Kane JM. Dosage strategies with long-acting injectable neuroleptics, including haloperidol decanoate. J Clin Psychopharmacol 1986 6(suppl) 20S-23S. 

Small andKellams (1974) noted reports of patients becoming suicidal as a result of treatment with the long-acting injectable form of Prolixin. Others have confirmed that suicide can result from neuroleptic-induced depression (Alarcon et al., 1969 Hogan et al., 1983). 

Neuroleptic-induced depression was recognized as a problem by Mayerhoff and Lieberman (1992), who pointed out that reported incidence rates of neuroleptic-induced so-called akinetic depression reach as high as 50%, with an average of 25%. Frequency probably increases with the long-acting intramuscular neuroleptics. 

Neuroleptic drugs can cause a depression-like syndrome. This should be differentiated from neuroleptic-induced akinesia. Long-acting drugs have been particularly implicated (SED-11,107) (174). However, a double-blind, placebo-controlled, randomized study of long-acting neuroleptic drugs did not support this conclusion (405). 

Chlorpromazine is well absorbed mainly from the jejunum. It is extensively metabolized in the liver, which produces several active metabolites. When given intramuscularly, the phenothiazine neuroleptics avoid metabolic degradation (first-pass metabolism), making them more beneficial as long-acting depot antipsychotics (see Table 2). 

If partial response neuroleptics can be very useful (as well as long-acting... 

Table 22.2. Long-acting Neuroleptics for IM Depot Injection ...

The new neuroleptic (which also demonstrates that the keto group is not essential for activity) fluspirilene (IXb) has been shown to be an extr iely potent and long acting drug... 

Yamashita T, Fujii Y, Misawa F. Neuroleptic malignant syndrome associated with risperidone long-acting ii ection a case repert. J Clin Psychopharmacol 2013 33(l) 127-9. 

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