The British Journal of Psychiatry (2009) 195: S63-S67. doi: 10.1192/bjp.195.52.s63
© 2009 The Royal College of Psychiatrists
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REVIEW ARTICLES

Clinical guideline recommendations for antipsychotic long-acting injections

John M. Kane, MD

Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA

Carlos Garcia-Ribera, MD

Hospital del Mar, Institute for Psychiatric Assistance, Mental Health and Drug Addiction (IAPS-IMAS), Barcelona, Spain

Correspondence: Dr John M. Kane, Department of Psychiatry, Zucker Hillside Hospital, 75–59 263 Street, Glen Oaks, NY 11004, USA. Email: psychiatry{at}lij.edu

Declaration of interest

J.K. has been a consultant to or member of an advisory board for Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Janssen, Johnson & Johnson, Lundbeck, Otsuka, Pfizer, PGxHealth, Proteus, Vanda and Wyeth; he is a member of the speakers bureau for AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Janssen-Cilag. C.G.R. has been a consultant to AstraZeneca, Bristol-Myers Squibb, Otsuka and Sanofi-Synthelabo; he has been a speaker for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Novartis, Otsuka and Sanofi-Synthelabo.

Background

Long-acting injections (LAIs) of antipsychotic drugs were developed over 40 years ago in an attempt to improve the long-term treatment of schizophrenia.

Aims

To review existing guidelines concerning antipsychotic use generally, and LAIs in particular, and how patients might be identified as potential candidates for LAI treatment.

Method

Literature review.

Results

Currently several first-generation and one second-generation antipsychotic LAIs are available, with others under development. Although the use of LAIs is widespread around the world, patterns of use vary widely. Important considerations regarding the use of LAIs include the indications for long-term pharmacotherapy in schizophrenia in general, the indications for LAIs, the risks associated with LAIs, the need to update guidelines and the issue of cost.

Conclusions

The use of these injections in first-episode psychosis and treatment-refractory schizophrenia is not currently a focus of recommendations, but should be considered. Long-acting injections remain an underutilised option in many countries despite frequent non-adherence with oral medication and subsequent relapse.