First-Line Choice of an Antipsychotic LAI:
A first-generation depot antipsychotic should be chosen from the NHSGG&C Formulary*
Current evidence indicates that zuclopenthixol decanoate is more effective in preventing relapse than other first generation antipsychotic depots1.
*Exception to first line choice of FGA LAI:
Where there is good evidence of effect and tolerability with a specific SGA oral medication favouring its use as an LAI and where adherence with the oral medication is problematic. (Note: Paliperidone LAI over risperidone LAI should be considered for people who have responded well to oral risperidone and fit the exception criteria).
Second-Line Choice of an Antipsychotic LAI:
In the event of treatment failure or emergent, intolerable side-effects with the first-line choice:
An alternative first-generation depot medicine should be chosen from NHSGG&C Formulary*
*Exception: If emergent side-effects include extrapyramidal side effects or tardive dyskinesia then consider a formulary SGA LAI.
The differential in acquisition costs of FGA LAIs vs SGA LAIs
New initiations for SGA LAIs will now be subject to approval by local clinical director.
Any new request to initiate a SGA LAI should be made in writing to the respective CD for the service with a clear rationale for the choice of a SGA LAI over a first line choice of a FGA LAI.