Can We Rely on AGNP Therapeutic Targets Also For LAI Antipsychotics?

Baldelli, Sara; Clementi, Emilio; Cattaneo, Dario

doi:10.1055/s-0043-122603

Cited by 11 publications

(10 citation statements)

References 7 publications

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“…A more detailed description of the PK/PD properties and interactions of LAIs is reviewed elsewhere. 14,[27][28][29]…”

Section: Relevance Of Pharmacokinetic and Pharmacodynamic Aspects Of mentioning

confidence: 99%

“…An overview of clinically relevant drug interactions for first- and second-generation LAIs is shown in Supplemental Table 2. A more detailed description of the PK/PD properties and interactions of LAIs is reviewed elsewhere 14 , 27 – 29…”

Section: Relevance Of Pharmacokinetic and Pharmacodynamic Aspects Of mentioning

confidence: 99%

“…Moreover, the only available guidelines for the therapeutic targets of LAI antipsychotics, produced by Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), are based on data from oral compounds. 14,15 Therefore, HCPs must currently rely on their own clinical judgment to manage patients with breakthrough symptoms or symptomatic worsening. Herein, we provide practical solutions based on a framework of clinical, pharmacokinetic (PK), and dosing considerations to help HCPs make well-informed decisions regarding management strategies for patients presenting with breakthrough psychotic symptoms or symptomatic worsening while being treated with LAI antipsychotics.…”

Section: Introductionmentioning

confidence: 99%

“…There are currently no algorithms, treatment guidelines, or clinical pathways to guide the management of LAI antipsychotic–treated patients who have breakthrough symptoms or who become acutely ill. Moreover, the only available guidelines for the therapeutic targets of LAI antipsychotics, produced by Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), are based on data from oral compounds 14 , 15 . Therefore, HCPs must currently rely on their own clinical judgment to manage patients with breakthrough symptoms or symptomatic worsening.…”

Section: Introductionmentioning

confidence: 99%

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Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics

et al. 2018

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With more long-acting injectable (LAI) antipsychotics available for treating schizophrenia, each with variable durations of action (2 weeks to 3 months), it is important to have clear management strategies for patients developing breakthrough psychotic symptoms or experiencing symptomatic worsening on LAIs. However, no treatment guidelines or clinical practice pathways exist; health-care providers must rely on their own clinical judgment to manage these patients. This article provides practical recommendations—based on a framework of clinical, pharmacokinetic, and dosing considerations—to guide clinicians’ decisions regarding management of breakthrough psychotic symptoms. Management options include ruling out/addressing medical illness or substance abuse/misuse as a contributing factor, addressing stressors, optimizing nonpharmacologic treatments, treating medical/psychiatric comorbidities, ensuring proper LAI administration technique, addressing missed LAI doses or lack of steady-state attainment, and increasing LAI dose directly or indirectly by shortening the injection interval (off-label). If these strategies do not work sufficiently with frequent monitoring, the LAI could be supplemented with a low dose of the corresponding oral formulation for fast symptom control (off-label). However, caution should be exercised with this strategy, because data on the safety of concomitant use of LAI and oral antipsychotics (OAPs) are limited, especially over extended periods. If symptoms abate, therapy optimization could be continued and slow discontinuation of the OAP could be considered. For persistent/worsening symptoms, the OAP should be increased to optimum effective dose while intensifying the initial steps used before it was added. If this fails, switching the OAP or LAI could be considered. We believe that these strategies will help clinicians manage breakthrough psychotic symptoms during LAI treatment and improve overall outcomes among those who can benefit from LAIs.

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“…A more detailed description of the PK/PD properties and interactions of LAIs is reviewed elsewhere. 14,[27][28][29]…”

Section: Relevance Of Pharmacokinetic and Pharmacodynamic Aspects Of mentioning

confidence: 99%

Section: Relevance Of Pharmacokinetic and Pharmacodynamic Aspects Of mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics

et al. 2018

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show abstract

“…Due to lack of data, the third and latest version of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Consensus Guidelines for therapeutic drug monitoring (TDM) in psychiatry and neurology adopted the reference ranges of the oral formulations for the LAI medications [2,3]. This option is far from ideal [4]. To study therapeutic reference ranges, a key issue is the time needed to reach steady state, which is determined by the half-life (t 1/2 ) of the compound.…”

mentioning

confidence: 99%