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ANTI-PSYCHOTICS DEPOT INJECTIONS Dr. Kenneth Orimma B.Sc., M.Sc., M.B.B.S, D.I.R, D.M(Doctor of Medicine) Psychiatry
ANTIPSYCHOTICS DEPOT INJECTIONS ANTIPSYCHOTIC DEPOT INJECTIONS An overview
ANTIPSYCHOTICS DEPOT INJECTIONS General classification • Intramuscular formulations of antipsychotics can be sub-divided into two groups based on their pharmacokinetic features: short-acting preparations and long-acting or depot preparations.
ANTIPSYCHOTICS DEPOT INJECTIONS Generic names/Brand names. Depot / LAI must always be prescribed generically
ANTIPSYCHOTICS DEPOT INJECTIONS Indications • For maintenance therapy of schizophrenia - more conveniently given than oral antipsychotic preparations ensuring better patient compliance. • For prophylaxis of bipolar affective disorder in patients who have poor compliance with oral prophylactic medication (antimanic drugs) depot medication certainly protects against hypomania relapse and some clinicians believe it also protects against a subsequent depressive relapse. • Short-acting intramuscular formulations are used to manage acute psychotic episodes. • Long-acting compounds, also called "depot", are administered as antipsychotic maintenance treatment to ensure compliance and to eliminate bioavailability problems related to absorption and first pass metabolism.
ANTIPSYCHOTICS DEPOT INJECTIONS Adverse reactions • Adverse effects of antipsychotics have been studied with respect to oral versus short- and long-acting intramuscular formulations of the different compounds. • For short-term intramuscular preparations the main risk with classical compounds are hypotension and extrapyramidal side effects (EPS) • Data on the incidence of EPS with depot formulations are controversial: some studies point out that the incidence of EPS is significantly higher in patients receiving depot preparations, whereas others show no difference between oral and depot antipsychotics.
ANTIPSYCHOTICS DEPOT INJECTIONS Fluphenazine decanoate Indications 1. Useful in treating agitated or aggressive schizophrenic patients. 2. May be useful for the control of aggressive patients (in view of its sedative nature). Adverse effect • Contraindicated in severely depressed states - in view of its tendency to cause depression.
ANTIPSYCHOTICS DEPOT INJECTIONS Flupenthixol decanoate Indication • Useful in treating retarded or withdrawn schizophrenic patients – in view of its apparent alerting nature. Adverse effect • Not suitable for the treatment of agitated or aggressive schizophrenic patients - since it can cause over-excitement in such patients in view of its alerting nature.
ANTIPSYCHOTICS DEPOT INJECTIONS Zuclopenthixol decanoate Indications 1. Useful in treating agitated or aggressive schizophrenic patients. 2. May be useful for the control of aggressive patients (this specific indication is more clearly established for zuclopenthixol decanoate - cf fluphenazine decanoate) in view of its sedative nature (zuclopenthixol decanoate is more sedative than fluphenazine decanoate). Adverse effect • Not suitable for the treatment of retarded or withdrawn schizophrenic patients - since it may exacerbate psychomotor retardation in such patients in view of its sedative nature.
ANTIPSYCHOTICS DEPOT INJECTIONS Haloperidol decanoate Indication • Maintenance in schizophrenia and other psychosis; usually 4-weekly administration.
ANTIPSYCHOTICS DEPOT INJECTIONS IM risperidone Indication 1. The world's first ever atypical antipsychotic long-acting intramuscular injection. 2. Licensed for the treatment of both the positive and negative symptoms of schizophrenia; it also alleviates affective symptoms associated with schizophrenia; 2-weekly administration. 3. May be the 'depot' (long-acting intramuscular injection) of choice in patients with bipolar affective disorder who are poorly compliant with oral antimanic drugs. Adverse effect • Less EPSE, cf other conventional antipsychotic depot injections.
ANTIPSYCHOTICS DEPOT INJECTIONS THE END THANK YOU VERY MUCH
