Risperidone long-acting injection: a review of its long term safety and efficacy

Abstract

A long-acting form of the second-generation antipsychotic drug risperidone is now broadly available for the treatment of schizophrenia and closely related psychiatric conditions. It combines the advantage of previously available depot formulations for fi rst-generation drugs with the favorable characteristics of the modern "atypical" antipsychotics, namely higher effi cacy in the treatment of the negative symptoms of schizophrenia and reduced motor disturbances. Published clinical studies show an objective clinical effi cacy (as per psychiatric symptom scores and relapse data) that exceeds that of oral atypical antipsychotics when patients are switched to the long-acting injectable form, a low incidence of treatment-emergent extrapyramidal side effects, and very good acceptance by patients. Available data for maintenance treatment of bipolar disorder show equivalence with the oral form instead of superiority, but are still limited. As it seems likely that effi cacy benefi ts are mostly due to the fact that the injectable form reduces the demand for patient compliance to one physician visit every 2 weeks instead of self-administration on a daily or twice-daily basis, additional potential could exist in other psychiatric disorders where atypical antipsychotic drugs are of benefi t but where patient adherence to treatment schedules is typically low.

Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder

“…The two groups completed the Positive and Negative Symptom Scale (PANSS),15 and the Hamilton Rating Scale of Depression (HRSD) 16. If the patient was undergoing antipsychotic combination therapy, we transformed each antipsychotic dosage into its chlorpromazine equivalent dose and calculated the total dose 17-20…”

Evaluating Appropriateness of Prescribing of Long-Acting Risperidone for Injection in Acute Care Settings

“…12 Prescribers should be aware that the drug has a significantly slower onset of action than conventional antipsychotic depot drugs. 13 In this study, 13% of patients did not receive 3 full weeks of antipsychotic supplementation.…”

Patient perspectives on use of long-acting antipsychotics in bipolar disorder: focus on risperidone injection

“…32,34,35 There does not seem to be a major difference in terms of neurologic (extrapyramidal) effects, endocrine (hyperprolactinemia) tolerance, and weight gain between the oral and long-acting forms. The adverse drug reactions linked to injection (pain, inflammation) seem less frequent with long-acting risperidone compared with first-generation antispychotics.…”

“…31 The doses administered by long-acting injections are therefore markedly lower than those used orally for the same effect and possibly improve tolerance to treatment. 32 The ideal stability of the plasma level of the product compared with the oral form is also an important element. The use of long-acting risperidone ensures improved stability in product time and of its active metabolite (risperidone + 9-hydroxyrisperidone).…”

“…34 It is also advisable to highlight the absence of overdose risk and administration being controlled, especially in the case of a suicidal medical history. 32 Long-acting injectable formulations of second-generation antipsychotics could combine the effect of oral second-generation antipsychotics in patients with bipolar disorder and the benefits of depot formulation, with the assurance of steady medication delivery and improved adherence.…”