Missed Depot (LAI) during Covid-19 pandemic

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First generation

No information available from manufacturers.  Contact mental health pharmacy department for advice.

Aripiprazole

The table below provides guidance on missed doses:1

If 2nd or 3rd dose is missed and time since last injection is:

Action

> 4 weeks and < 5 weeks

The injection should be administered as soon as possible and then the monthly injection schedule should be resumed.

> 5 weeks

Concomitant oral aripiprazole * should be restarted for 14 days with next administered injection.

If 4th or subsequent doses are missed (i.e., after attainment of steady state) and time since last injection is:

Action

> 4 weeks and < 6 weeks

The injection should be administered as soon as possible and then the monthly injection schedule should be resumed.

> 6 weeks

Concomitant oral aripiprazole * should be restarted for 14 days with next administered injection and then resume monthly injection schedule.

*10-20mg oral aripiprazole daily

Paliperidone monthly (Xeplion)

The option to switch to three monthly paliperidone palmitate can be considered for patients who have been clinically stable on monthly paliperidone palmitate injection for 6 months. At this time there will be no need to complete a non-formulary request form.

To avoid a missed monthly maintenance dose, patients may be given the injection up to 7 days before or after the monthly time point. However if a dose is missed follow the advice below:2

Time since last injection

Action

1 month to 6 weeks

  • Previously stabilised dose should be administered as soon as possible
  • Followed by injections at monthly intervals.

>6 weeks to 6 months

For patients stabilised with doses of 25 to 100 mg

1.       A deltoid injection as soon as possible at the same dose the patient was previously stabilised on

2.       Another deltoid injection (same dose) one week later (day 8)

3.       Resumption of the normal monthly cycle of injections

For patients stabilised with 150 mg

1.       A deltoid injection as soon as possible at the 100 mg dose

2.       Another deltoid injection one week later (day 8) at the 100 mg dose

3.       Resumption of the normal monthly cycle of injections

>6 months

  • To be given as per normal recommended initiation e.g 150mg on day 1 & 100mg on day 8.
  • Thereafter give monthly injections in either the deltoid or gluteal muscle of 25 mg to 150 mg based on individual patient tolerability and/or efficacy.
Paliperidone 3-monthly (Trevicta)

TREVICTA should be injected once every 3 months. To avoid a missed dose of TREVICTA patients may be given the injection up to 2 weeks before or after the 3-month time point. However if a dose is missed follow the advice below:3

Time since last injection

Action

> 3½ months up to 4 months

The injection should be administered as soon as possible and then resume the 3-monthly injection schedule.

4 months to 9 months

Use the recommended re-initiation regimen shown in the table below.

> 9 months

Re-initiate treatment with 1-monthly paliperidone palmitate injectable as described in the prescribing information for that product. TREVICTA can then be resumed after the patient has been adequately treated with 1-monthly paliperidone palmitate injectable preferably for four months or more.

Recommended re-initiation regimen after missing 4 months to 9 months of TREVICTA

If the last dose of TREVICTA was

Administer 1-monthly paliperidone palmitate injectable, two doses one week apart (into deltoid muscle)

Then administer TREVICTA (into deltoida or gluteal muscle)

Day 1

Day 8

1 month after day 8

175 mg

50 mg

50 mg

175 mg

263 mg

75 mg

75 mg

263 mg

350 mg

100 mg

100 mg

350 mg

525 mg

100 mg

100 mg

525 mg

Risperidone (Ref 4,5)

Risperidone should be given every 2 weeks.

The main release of risperidone starts 3 weeks after the injection, is maintained from 4 to 6 weeks, and subsides by week 7.

A missed dose should be given as soon as possible and carried on fortnightly thereafter.

The patient should be monitored closely for breakthrough symptoms as oral supplementation may be needed.

Do not give a double dose or higher dose because that could lead to toxic levels 3-5 weeks later.

References
  1. Abilify Maintena 400 mg powder and solvent for prolonged-release suspension for injection SmPC. Last updated 14/05/19. Accessed online 30/03/20. https://www.medicines.org.uk/emc/product/7965/smpc
  1. Xeplion 100 mg prolonged-release suspension for injection (paliperidone palmitate) SmPC. Last updated 24/10/18. Accessed online 30/03/20. https://www.medicines.org.uk/emc/product/7652/smpc#POSOLOGY
  2. Trevicta prolonged release suspension for injection (paliperidone palmitate) SmPC. Last updated 20/11/19. Accessed online 30/03/20. https://www.medicines.org.uk/emc/product/7230/smpc
  3. Stephen Bazire. Psychotropic Drug Directory. London: Lloyd-Reinhold Publications; 2018.
  4. Risperdal Consta 25 mg powder and solvent for prolonged-release suspension for injection SmPC. Last updated 06/12/18. Accessed online 01/04/20. https://www.medicines.org.uk/emc/product/1690/smpc#PHARMACOKINETIC_PROPS
Editorial Information

Last reviewed: 07 April 2020

Next review: 01 April 2021

Author(s): Mental Health Pharmacy Services

Version: 1

Approved By: Mental Health Pharmacy Services

Reviewer Name(s): Andrew Walker, Suzanne Burke