Long-Acting Schizophrenia Drugs May Cut Relapse Rate
If you're like many people, you'd much rather take a pill than have a shot. But what if choosing the shot could help keep you out of the hospital?
A large study from Finland looked at more than 2,500 patients right after their first hospital stay for schizophrenia. The risk of having to go back to the hospital was lower for people who took their antipsychotic medication via a long-acting injection, compared to those who took it by mouth.
A New Look at Long-Lasting Treatment
Several antipsychotic medications are available in a long-acting form that can be taken by injection every two to four weeks. These drugs include:
- Aripiprazole (Abilify Maintena)
- Olanzapine (Zyprexa Relprevv)
- Paliperidone (Invega Sustenna)
- Risperidone (Risperdal Consta)
- Fluphenazine (Prolinin Decanoate)
- Haloperidol (Haldol Decanoate)
Long-acting injections of antipsychotic drugs are nothing new. The first ones were developed in the 1960s. For years, however, injections were reserved mainly for the worst cases. That earned them a bad reputation, which has been tough to shake. Yet recent research suggests that it may be time to reconsider.
With oral medication, about half of people with schizophrenia don't take all their pills. Some forget a dose now and then. Others skip their medication most of the time.
"A physician never knows who is getting the full amount and who isn't," says Jean-Pierre Lindenmayer, M.D., director of psychopharmacology research at New York University. That can reduce the effectiveness of treatment. In contrast, you and your physician know exactly how much of the drug you're getting in an injection.
Injection Pros and Cons
"If you compare milligram by milligram, the effectiveness of the medication is the same whether it's taken by injection or by mouth," says Dr. Lindenmayer.
But some people skip their pills or have a hard time remembering if they took them. Others might not want people to see that they need daily medications, or they might simply prefer the convenience of taking medication only once or twice a month. All of these reasons can make it a better option to take the medication via injection. You're more likely to have the right amount of drug in your system when you get it by injection. And that may reduce your risk for relapse or re-hospitalization.
"Side effects of the injections are, by and large, the same as for oral medications," Dr. Lindenmayer says. Sometimes, there are even fewer side effects, since your medication levels aren't going up and down every day.
One exception is postinjection delirium sedation syndrome (PDSS), a rare but serious side effect of olanzapine injections only. In PDSS, medication gets into the bloodstream too quickly, causing an overdose reaction. Symptoms usually start within three hours of getting an injection of olanzapine. Seek medical help immediately for:
Trouble walking or talking
- Loss of consciousness
The biggest drawback to long-acting injections is that so many people don't like to get shots—and some psychiatrists don't like to give them. But both patients and doctors are taking a second look at this option today. In fact, when asked, most patients who tried an antipsychotic via injection either liked it the same as pills or liked it better. A shot isn't fun, but if it can keep you out of the hospital, it could be well worth it. Explore your options with your psychiatrist.
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- Medication Guide: Zyprexa Relprevv. Eli Lilly, 2009, on the Food and Drug Administration website http://www.fda.gov/downloads/Drugs/DrugSafety/UCM194579.pdf
- Paliperidone. National Library of Medicine. May 16, 2011. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a607005.html
- Fluphenazine. National Library of Medicine. May 16, 2011. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682172.html
- Haloperidol. National Library of Medicine. May 16, 2011. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682180.html