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Antipsychotic Depot (LAI) Injections & Monitoring

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Contents:

What is a Depot Injection?
Antipsychotic Depot Injections
Administration
Antipsychotic Drugs and Schedules
Monitoring
Missed Doses

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Summary: Information about how to administer depot/long acting injections, monitor patient health under this type of treatment and what to do if a dose is missed.

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Who’s it for: Practice Nurse, Mental Health Nurse, GP

What is a Depot Injection?

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A depot injection, also known as a Long Acting Injection (LAI), is an injection formulation of a medication which releases slowly over time to permit less frequent administration. They are designed to increase medication adherence and consistency, especially in patients who commonly forget to take their medicine.

Depot injections can have a duration of action of one month or greater and are available for many types of drugs, including antipsychotics (see 💉Antipsychotic Depot (LAI) Injections & Monitoring) and hormones (see 💉Depo-Provera (Contraceptive) Injections or 💉Leuprorelin & Zoladex Injections ).

Antipsychotic Depot Injections

This type of medication is always initiated by secondary care team (psychiatrist) and then handed over to the GP practice when appropriate in a Shared Care Agreement (see 🤝Shared Care Agreements for more info). Once an agreement is in place, you should be able to find it on EMIS.

This means that:

When antipsychotics are initiated, baseline measurements should be taken in secondary care.
Starting doses will be administered by the specialist psychiatric (secondary care) team.
People with a psychotic disorder will remain under the responsibility of the secondary care team for the first 12 months, or until their condition has stabilised (whichever is longer).
The specialist team will continue to administer the injections until the GP agrees to shared care.
Prescribing responsibility will only be transferred when the consultant and the GP are in agreement that the patient’s condition is stable or predictable.
GPs should contact the psychiatrist/secondary team before making any dose adjustments.

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Once shared care is in place, patients should contact their GP (and/or specialist) if they:

have concerns about their medication;
want to discuss stopping medication;
are considering becoming pregnant;
suspect they are pregnant;
wish to breastfeed;
have been prescribed medication by another specialist service, so that drug interactions can be checked.

Administration

These medications are administered as intramuscular (IM) injections. See our page on 💪🏻Intramuscular Injections for details on how to perform an IM injection.

Antipsychotic Drugs and Schedules

*NB: patients taking clozapine and olanzapine are managed exclusively in secondary care.

Brand name	Drug name	Dose/amount	How often
Modecate	Fluphenazine decanoate	up to 100 milligrams	1 injection every 2 to 5 weeks according to response and severity of condition
Depixol	Flupenthixol decanoate	up to 400 milligrams	1 injection every 2 to 4 weeks according to response and severity of condition
Haldol	Haloperidol decanoate	up to 300 milligrams	1 injection every 2 to 4 weeks according to response and severity of condition
Piportil	Pipothiazine palmitate	up to 200 milligrams	1 injection every 4 weeks
Clopixol	Zuclopenthixol Decanoate	up to 600 milligrams	1 injection every 1 to 4 weeks
Risperdal Consta	Risperidone	up to 50 milligrams	1 injection every 2 weeks
Xepilon	Paliperidone	up to 150 milligrams	1 injection every 4 weeks
ZypAdhera*	Olanzapine embonate	up to 405 milligrams	1 injection every 2 or 4 weeks
Abilify Maintena	Aripiprazole	up to 400 milligrams	1 injection every month

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Needle know-how for antipsychotic depot injections

Aripiprazole, Paliperidone Trevicta or Risperidone will come pre-packaged with needles and syringes.
Oil based depots (e.g. zuclopenthixol and haloperidol) will come packaged as small glass vials with no pre-packaged syringes and needles.
Where needles are supplied with an injection, use ONLY those needles.
Where manufacturers provide equipment for the injection of their products, that equipment MUST be used.
Follow all instructions advising to shake a vial for a specified amount of time (e.g.,10 seconds). Suspensions should be homogenous prior to injection.
Alcohol swabbing is not necessary unless the skin is very unclean or patient is immunocompromised.

If cleaning site → 70% isopropyl alcohol swab, allow 10 seconds for skin to dry.

No post injection monitoring is required for any of these medications.

Monitoring

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If side effects persist or emerge, contact the specialist psychiatric team or medicines information.

Regular monitoring may subsequently be done in primary care on specialist advice or depending on the person's care plan.

Tests which need to be done every 12 months may be carried out at the annual physical review (see 🧠Severe Mental Illness (SMI)).

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Monitoring tests may include:

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Toxicity of antipsychotic medicines

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The Medicines and Healthcare products Regulatory Agency (MHRA) advises:

Missed Doses

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Does Not Attend (DNA) for a Depot Injection

Patients requiring Antipsychotic Depot injections are considered ‘vulnerable patients’. They require treatment in a timely manner and disruption of this schedule can be a serious issue. Therefore, safety netting reminders for treatment should be set, and any concerns, including DNAs, should be flagged to the Care Coordinator and/or Safeguarding Lead.

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If patient misses a dose, speak to a GP at your site or the secondary care team if you are unsure how to resume treatment. You can also check the Electronic Medicines Compendium (EMC) guidance linked below for advice about actioning missed doses and schedules.

Click the correct medication below, select correct dosage, then go to: Clinical Particulars → Posology and method of administration

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Resources: