Pros and Cons of Long-Lasting Antipsychotic Drugs

Keeping up with your schizophrenia medicine makes all the difference. It curbs symptoms like seeing and hearing things that aren't there. Along with psychiatric therapy, a pill you take every day can put you on the path to a stable, successful life.

But there's a catch: A lot of folks quit their meds.

Sometimes they just forget to take them. Or they may think they're well enough that they don't need them anymore.

That's where long-lasting drugs can help. You need to take them as a shot only once or twice a month.

How Do They Work?

Long-lasting drugs, which your doctor may call long-acting injectables, improve symptoms the same way as pills called antipsychotics. They change how some of your brain chemicals act.

But since you take them every 2 to 4 weeks (or sometimes even as long as every 3 months) instead of every day, the medicine stays in your body longer.

These antipsychotic drugs come in a long-lasting form:

Paliperidone also comes in a newer formula, marketed as Invega Trinza, that you take just four times a year. To get a prescription for this medicine, you first need to use Invega Sustenna, which you take monthly, for at least 4 months.

You don't inject long-acting drugs yourself. You need to go to a doctor or a nurse, who uses a needle to put the medicine into your upper arm or buttocks. Once the medicine gets into your muscle, it's slowly released into your body over days, weeks, or months.

What Are the Advantages?

Anyone who has to take a daily pill knows that it can be tough to stay on schedule. But people with schizophrenia and other serious forms of mental illness have extra challenges.

They sometimes don't think they are sick, especially in the early stages of their disease. They may hear voices that persuade them not to take medication. If they do take it, they might stop as soon as their symptoms go away.

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In several studies, only 40% to 60% of people with schizophrenia stay on track with their daily meds.

Long-acting drugs solve the problem of having to take medicine every day. And because a health care professional has to give you the shot, it's easier for your doctor to know whether you're keeping up with your treatment.

Generally, long-lasting drugs are recommended for people whose symptoms get better with pills or liquid meds, but who have trouble taking them every day. So they're often not prescribed until someone has had schizophrenia for several years.

But a study from UCLA suggests that people who recently found out they have schizophrenia can benefit from long-acting drugs, too. In that study, those who got shots every two weeks were more likely to stick with their treatment plan than people who were prescribed daily pills. Very few of the people who got the shots -- just 5% -- had their symptoms come back, compared with 33% in the pill group.

What Are the Downsides?

Because you have to go to a doctor or hospital to get the shots, it's not as quick and simple as taking a pill at home. You'll need to make time for these appointments, and make sure you can get there and back safely. And like with any injection, you may feel some pain or soreness during or after each shot.

A serious side effect called post-injection delirium sedation syndrome affects less than 1% of people after taking olanzapine pamoate (Zyprexa Relprevv), a long-acting medicine. It can cause dizziness, confusion, and movements you can't control, and it usually happens within an hour of getting a shot. Because of this small risk, you'll need to stay at your doctor's office for at least 3 hours after your shot so you can be watched for side effects.

Antipsychotic medicines can also make you sleepy or dizzy, and they can cause skin rashes, rapid heartbeat, blurred vision, and muscle shakiness or stiffness. Some can also make you gain weight and put you at risk for diabetes or high cholesterol.

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These side effects can happen whether you take the daily pill or the shot. The difference is that the long-acting type takes more time to leave your body. Your doctor can stop or change the dosage of daily medicine that's causing a bad reaction, but you'll have to wait weeks for a long-lasting drug to run its course.

If side effects such as drowsiness or muscle shakiness or stiffness don't end on their own, a doctor might prescribe another medicine to treat those symptoms. Before you start taking a long-lasting drug, your doctor will probably prescribe the daily pill form first, so you can be sure it works well for you.

You may also have to continue taking your daily pill for the first few weeks after getting your first long-acting shot, since it will take some time for enough of the drug to get released into your body.

Your doctor can help you decide what type of medicine is best. You may have to try several to find the right one for you. Whether you end up using a daily pill or a long-lasting drug, chances are there's one that can help you manage your schizophrenia or bipolar symptoms.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on July 17, 2018

Sources

SOURCES:

National Institute of Mental Health.

News release, University of California, Los Angeles.

FDA.

News release, Janssen Pharmaceuticals Inc.

UpToDate: "Pharmacotherapy for schizophrenia: Long-acting injectable antipsychotic drugs."

Valenstein, M. Schizophrenia Bulletin, 2004.

Osborne, R. Health and Quality of Life Outcomes, April 2012.

National Alliance on Mental Illness: "Mental Health Medications."

Rosenheck, R. New England Journal of Medicine, March 2011.

Brissos, S. Therapeutic Advances in Pharmacology, October 2014.

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