Risperidone long-acting

Depot antipsychotics (e.g., haloperidol decanoate, fluphenazine decanoate, and risperidone long-acting injection) can be used for maintenance therapy of bipolar disorder with noncompliance or treatment resistance. 

Parellada E, Andrezina R, Milanova V, Glue P, Masiak M, Turner MS, Medori R, Gaebel W. Patients in the early phases of schizophrenia and schizoaffective disorders effectively treated with risperidone long-acting injectable. J Psychopharmacol 2005 19(5 Suppl) 5-14. 

Risperidone long-acting depot microspheres formulation for deep intramuscular administration 25 mg vial/kit, 37.5 mg vial/kit, 50 mg vial/kit... 

The addition of aripiprazole to risperidone long-acting injection resulted in a decrease in prolactin levels with improvement in symptoms of hyperprolactinemia in two separate cases a 27-year-old female on aripirazole 15 mg per day [260A, 261 A]. 

Alphs L, Bossie CA, Sliwa JK, Fu D-J, Ma Y-W, Hulihan J. Paliperidone pahnitate and risperidone long-acting injectable in subjects with schizophrenia recently treated with oral risperidone or other oral antipsychotics. Neuropsychiatr EHs Treat 2013 9 341-50. 

Wheeler A, Vanderpyl J, Carswell C, Stojkovic M, Robinson E. One-year treatment continuation in patients prescribed risperidone long-acting injection in New Zealand a retrospective study. Clin Schizophr Relat Psychoses 2012 6(2) 61-8. 

Suzuki H, Gen K. The influence of switching from oral risperidone to risperidone long-acting injection on the clinical symptoms and cognitive function in schizophrenia. Ther Adv Psychopharmacol 2012 2(l) 23-9. 

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. 

Ziadi Trives M, Bonete Llacer JM, Garcia Escudero MA, Martinez Pastor CJ. Effect of the addition of aripiprazole on hyperprolactinemia associated with risperidone long-acting injection. J Clin Psychopharmacol 2013 33(4) 538-41. 

Current tardive dyskinesia History of non-adherence Clozapine, quetiapine Long-acting risperidone Risperidone, olanzapine, ziprasidone... 

Difficulty swallowing tablets/capsules Risperidone or aripiprazole liquid, orally-disintegrating tablets (risperidone, olanzapine, clozapine) Long-acting risperidone... 

If partial or poor adherence is an issue, a long-acting or depot injectable antipsychotic should be considered (e.g., risperidone microspheres, halo-peridol decanoate, fluphenazine decanoate). 

Haloperidol and fluphenazine decanoate should be administered by a deep, Z-track IM method. Long-acting risperidone is injected by deep IM injection in the gluteus maximus, but Z-tracking is not necessary. 

In the Expert Consensus survey (Rush and Frances, 2000) the expert clinicians rated newer atypical antipsychotics highest for treatment of schizophrenic patients who are compliant with medication. Risperidone was rated highest of the atypicals, followed by olanzapine. In the case of patients with numerous failed trials with other antipsychotics, the experts voted for clozapine. For patients noncompliant with oral medication, respondents endorsed long-acting depot antipsychotics. Once again, these were impressions based on personal clinical experiences rather than hard empirical data. 

For patients with chronic psychotic symptoms who do not comply with a daily medication regimen, a long-acting depot preparation should be considered after stabilization with oral medication. Fluphenazine, haloperidol, and risperidone are the only long-acting injectable antipsychotic medications currently available in the United States. 

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. 

Bhanji NH, Chouinard G, Margolese HC. A review of compliance, depot intramuscular antipsychotics and the new long-acting injectable atypical antipsychotic risperidone in schizophrenia. Eur Neuropsychopharma-col. 2004 14 87-92. 

Gharabawi, G. M., Bossie, C. A., Zhu, Y., Mao, L., Lasser, R. A. 2005, An assessment of emergent tardive dyskinesia and existing dyskinesia in patients receiving long-acting, injectable risperidone results from a long-term study, Schizophr.Res., vol. 77, no. 2-3, pp. 129-139. 

Remington et al. (2006) conducted a similar PET study of the long-acting injectable form of risperidone at doses of 25, 50, or 75 mg every 2 weeks. After reaching stabilization, nine patients with a diagnosis of schizophrenia or schizoaffective disorder were scanned twice, 3 days postinjection and 5 days before the next injection. According to Remington et al. (2006), all three doses of injectable risperidone showed peak D(2) occupancy levels above the 65% threshold associated with optimal clinical response the 75-mg dose approximated the 80% threshold linked to increased risk of extrapyramidal reactions. Clearly, it is all in the dose all of the atypicals are potent dopamine blockers. 

Adamou, M., Hale, A. (2004). Extrapyramidal syndrome and long-acting injectable risperidone. American Journal of Psychiatry, 161, 756-757. 

Remington, G., Mamo, D., Labelle, A., Reiss, J., Shamrru, C., Mannaert, E., et al. (2006). A PET study evaluating D2 receptor occupancy for long-acting injectable risperidone. American Journal of Psychiatry, 163, 396—401. 

In a 12-week, double-blind study, 193 Caucasian, 174 African-American, and 72 subjects from other races, all of them with schizophrenia or schizoaffective disorder, were randomized to long-acting injectable risperidone (25, 50, or 75 mg every 2 weeks) or placebo (230). Race influenced neither efficacy nor extrapyramidal symptoms nor body weight. 

Turner M, Eerdekens E, Jacko M, Eerdekens M. Long-acting injectable risperidone safety and efficacy in stable patients switched from conventional depot antipsychotics. Int Clin Psychopharmacol 2004 19 241-9. 

Medori R, Llorca PM. Direct transition to long-acting risperidone—analysis of long-term efficacy. J... 

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