Podcast
Questions and Answers
Patients switching from oral risperidone should be switched to a dose of RLAI of 50mg every two weeks.
Patients switching from oral risperidone should be switched to a dose of RLAI of 50mg every two weeks.
False
When switching from oral antipsychotics not including risperidone, patients may need to taper oral risperidone over 1-2 weeks.
When switching from oral antipsychotics not including risperidone, patients may need to taper oral risperidone over 1-2 weeks.
True
The initial dose of RLAI for patients coming from higher oral doses should start at 37.5mg/2 weeks.
The initial dose of RLAI for patients coming from higher oral doses should start at 37.5mg/2 weeks.
True
Oral antipsychotics must be discontinued immediately upon starting RLAI.
Oral antipsychotics must be discontinued immediately upon starting RLAI.
Signup and view all the answers
For patients on depot antipsychotics, the initial RLAI dose prediction is generally straightforward.
For patients on depot antipsychotics, the initial RLAI dose prediction is generally straightforward.
Signup and view all the answers
RLAI should be given one week before the last depot injection for patients on antipsychotic polypharmacy.
RLAI should be given one week before the last depot injection for patients on antipsychotic polypharmacy.
Signup and view all the answers
For candidates on low oral doses of antipsychotics, the recommended starting RLAI dose is 50mg/2 weeks.
For candidates on low oral doses of antipsychotics, the recommended starting RLAI dose is 50mg/2 weeks.
Signup and view all the answers
Patients switching from oral antipsychotics must remain on RLAI for a minimum of 3 weeks before considering other treatments.
Patients switching from oral antipsychotics must remain on RLAI for a minimum of 3 weeks before considering other treatments.
Signup and view all the answers
Risperidone was the first SGA to be available as a long-acting injection.
Risperidone was the first SGA to be available as a long-acting injection.
Signup and view all the answers
Withdrawal from risperidone long-acting injection is reported in more than 10% of patients.
Withdrawal from risperidone long-acting injection is reported in more than 10% of patients.
Signup and view all the answers
Higher doses of risperidone long-acting injection are necessarily associated with better outcomes.
Higher doses of risperidone long-acting injection are necessarily associated with better outcomes.
Signup and view all the answers
The striatal dopamine D2 occupancy is considered therapeutic at 25mg of risperidone every two weeks.
The striatal dopamine D2 occupancy is considered therapeutic at 25mg of risperidone every two weeks.
Signup and view all the answers
The plasma levels of 25mg of risperidone administered every two weeks are equivalent to taking 4mg of oral risperidone per day.
The plasma levels of 25mg of risperidone administered every two weeks are equivalent to taking 4mg of oral risperidone per day.
Signup and view all the answers
Discontinuation rates for risperidone long-acting injection are higher compared to other FGA depot therapies.
Discontinuation rates for risperidone long-acting injection are higher compared to other FGA depot therapies.
Signup and view all the answers
Paliperidone palmitate is equivalent to 4mg of oral risperidone when administered at a dose of 150mg monthly.
Paliperidone palmitate is equivalent to 4mg of oral risperidone when administered at a dose of 150mg monthly.
Signup and view all the answers
Patients using doses higher than 75mg of risperidone every two weeks consistently show poor continuation rates.
Patients using doses higher than 75mg of risperidone every two weeks consistently show poor continuation rates.
Signup and view all the answers
Risperidone depot is an esterified form of the parent drug.
Risperidone depot is an esterified form of the parent drug.
Signup and view all the answers
Patients should be on a full dose of their previous antipsychotic for at least 6 weeks after the first risperidone injection.
Patients should be on a full dose of their previous antipsychotic for at least 6 weeks after the first risperidone injection.
Signup and view all the answers
Risperidone depot must be administered every 2 weeks without flexibility in scheduling.
Risperidone depot must be administered every 2 weeks without flexibility in scheduling.
Signup and view all the answers
Oral antipsychotic cover may not be necessary if a patient starts risperidone depot treatment.
Oral antipsychotic cover may not be necessary if a patient starts risperidone depot treatment.
Signup and view all the answers
A test dose of risperidone depot is usually required to ensure tolerability.
A test dose of risperidone depot is usually required to ensure tolerability.
Signup and view all the answers
It takes 3-4 weeks for the first injection of risperidone depot to reach therapeutic plasma levels.
It takes 3-4 weeks for the first injection of risperidone depot to reach therapeutic plasma levels.
Signup and view all the answers
Risperidone depot is recommended for patients with treatment-refractory schizophrenia.
Risperidone depot is recommended for patients with treatment-refractory schizophrenia.
Signup and view all the answers
The most effective way to predict response to risperidone long-acting injection is to establish the dose with oral risperidone.
The most effective way to predict response to risperidone long-acting injection is to establish the dose with oral risperidone.
Signup and view all the answers
Study Notes
Risperidone Long-Acting Injection (RLAI)
- Risperidone was the first atypical antipsychotic (FGA) to be available as a depot or long-acting injection.
- Doses of 25-50mg every two weeks are effective.
- Well-tolerated, with fewer extrapyramidal symptoms (EPS) and withdrawal symptoms compared to oral risperidone.
- Increases prolactin similar to oral risperidone, but levels may decrease after switching.
- Switching from FGA depots to RLAI may not be as successful as remaining on FGA depots.
- Discontinuation rates are lower for RLAI compared to other FGA depot therapy.
- Uncertainty about dose-response relationship for RLAI.
- Studies show no difference in response to fixed doses.
- A yearlong study suggested a better outcome with 50mg compared to 25mg, but no statistically significant differences.
- Higher doses may be associated with better outcomes according to other studies.
Risperidone Depot Information
- Risperidone depot is not an esterified form of the parent drug.
- Contains risperidone coated in polymer to form microspheres.
- The injection should be stored in a refrigerator.
- Available in 25mg, 37.5mg, and 50mg doses.
- The whole vial must be used due to the suspension nature, limiting flexibility in dosing.
- A test dose is not typically required or recommended.
- Tolerability with oral risperidone is preferred but not always possible.
- It takes 3-4 weeks for the first injection to reach therapeutic plasma levels.
- Patients should be on a full dose of their previous antipsychotic for at least 3 weeks after the first risperidone injection.
- Oral antipsychotic cover may be necessary for longer periods (6-8 weeks).
- If a patient isn't already receiving oral antipsychotic medication, oral risperidone should also be prescribed.
- Patients who refuse oral treatment and are acutely ill should not be given RLAI due to the long delay in drug release.
- Risperidone Depot must be administered every 2 weeks.
- The product license does not allow longer intervals between doses, limiting flexibility in negotiating with patients.
- Monthly injections might be possible but are not always effective.
Switching to Risperidone Long-Acting Injection (RLAI)
- For new patients or recently non-compliant patients: Start risperidone orally at 2mg/day and titrate to an effective dose. If tolerated, prescribe the equivalent dose of RLAI. Continue with oral risperidone for at least 3 weeks, then taper over 1-2 weeks. Be prepared to continue oral risperidone for longer.
- Use oral risperidone before giving injection to assure good tolerability.
- Those stabilized on 2mg/day start on 25mg/2 weeks.
- Those on higher doses start on 37.5mg/2 weeks and be prepared to use 50mg/2 weeks.
- Manufacturer advice may differ from this – guidance is based on numerous studies of dose-related outcome and on comparative plasma levels.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers key information about Risperidone Long-Acting Injection (RLAI), the first atypical antipsychotic available as a depot injection. It discusses dosing, side effects, and comparisons with oral risperidone and other FGA depot therapies. Test your knowledge on this important treatment option in psychiatry.
