The Game-Changer: Long-Acting Injectables (Depots)
Today, long-acting injectable antipsychotics (LAIs) represent a breakthrough in schizophrenia management. These formulations bypass the challenge of daily medication adherence, and instead offer sustained symptom control through injections administered at regular intervals ranging from 2 weeks to 3 months.
✅ Commonly Used LAIs in India – Quick Reference:
| Generic Name | Brand Name (India) | Frequency | Notes |
|---|---|---|---|
| Risperidone LAI | Risperdal Consta / Risperidone Consta | Every 2 weeks | Requires oral supplementation for first 3 weeks |
| Paliperidone palmitate 1-month | Invega Sustenna / Paliris | Monthly | No overlap with oral needed; steady plasma levels |
| Paliperidone palmitate 3-month | Invega Trinza | Every 3 months | Only after stabilization on monthly paliperidone |
| Olanzapine pamoate | Tolaz LA / Zyprexa Relprevv (brand name abroad) | Every 2–4 weeks | Effective, but requires 3-hour post-injection monitoring due to rare sedation syndrome |
| Aripiprazole monohydrate | Abilify Maintena (not yet widely available in India) | Monthly | Activating; useful in negative symptoms |
| Haloperidol decanoate | Trinicalm Depot / Trinacodol | Every 4 weeks | First-generation; inexpensive but higher risk of EPS |
| Fluphenazine decanoate | Prolinate (less common now) | Every 2–4 weeks | Traditional depot; used when cost is a key factor |
🧠 Clinical Highlights:
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Paliperidone (Paliris) is a versatile second-generation option with monthly and 3-month versions, offering sustained control for stable patients.
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Olanzapine (Tolaz LA) is effective in patients with severe agitation or psychosis, but post-injection monitoring limits use in OP settings.
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Risperidone Consta remains a workhorse in many clinics, but requires more frequent visits and a loading phase.
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Haloperidol depot (Trinacodol) remains a viable option for patients with limited access to second-generation medications.
💡 Choosing the Right LAI:
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New-onset schizophrenia: Paliperidone or risperidone (SGAs) often preferred
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Frequent relapses / poor compliance: Haloperidol depot or olanzapine LAI
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Sensitive to EPS or sedation: Paliperidone > Aripiprazole > Risperidone
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Stable patients preferring long gaps: Consider Paliperidone 3-monthly
The best outcomes come not just from the medicine, but from how it’s integrated into a recovery plan—including family support, education, and functional goals.