Using Long-Acting Injectables in Bipolar Disorder Treatment

For many patients with bipolar disorder or other psychotic disorders, using long-acting injectables (LAIs) as a treatment intervention can remove the stress of ensuring medication is taken regularly. Luckily, there are lots of LAI options available on the market right now, and 2 that are approved for use in bipolar disorder. Christoph U. Correll, MD, professor of psychiatry at Hofstra Northwell School of Medicine, New York, and medical director of the Recognition and Prevention program at the Zucker Hillside Hospital, reviews the available injectable options for bipolar disorder and schizophrenia and how they can benefit patients and clinicians alike. 

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Christoph Correll, MD, is a professor of psychiatry at Hofstra Northwell School of Medicine, New York, and medical director of the Recognition and Prevention program at the Zucker Hillside Hospital, New York. Dr Correll completed his medical studies at both the Free University of Berlin in Germany and at the Dundee University Medical School in Scotland. Dr Correll is board-certified in general psychiatry, having completed his residency at The Zucker Hillside Hospital in New York City.

Dr Correll’s research and clinical work focus on the identification, characterization, and psychopharmacological management of adults with severe psychiatric disorders. His areas of expertise range from the prodrome and first episode to the refractory illness phase of patients with severe mood and psychotic disorders. His research further focuses on psychotropic medication efficacy, effectiveness, and adverse effects as well as on physical health in the mentally ill.

Read the Transcript: 

Psych Congress Network: Tell us more about the use of LAIs for treating bipolar disorder. Who would be a good candidate for this therapy?

Dr Christoph Correll, MD: In the long-acting injectable worlds, independent of diagnosis, let's just start with that, has in the United States 2 typical antipsychotics: Haloperidol and Fluphenazine. And we have different atypical or second-generation antipsychotics. Risperidone microspheres, every 2 weeks. We have also Olanzapine that can be given.

We have several Risperidone. Other products than the microspheres that can be given monthly, like Perseris as a subcutaneous medication. There are also 2 under review with the FDA. One is a monthly Risperidone ISM, which is en situ microspheres. Another one is TV 46,000, a subcutaneous drug, that is Risperidone either given once monthly or twice monthly. And that achieves blood levels really very quickly. You don't need an extra booster or oral co-treatment.

And then we have the Aripiprazole products. Aripiprazole once-monthly, that's given once a month. And we have Aristata, Aripiprazole, Laroxyl, that is given every 4 weeks, every 6 or 8 weeks. So we have options, but they're restricted to, in the atypical world, to Risperidone paliperidone. And we have paliperidone once monthly, 3-monthly, and 6-monthly. Olanzapine, but that has the potential for post-injection sedation and coma syndrome—1 in every 1,200 injections. So you need to supervise a patient for 3 hours after the injection. It's not used much.

And we have the Aripiprazole products. That's the world of LAIs. We have others under development, such as Lumateperone and the deuterated version. And also we have Brexpiprazole that is being developed.

What about bipolar disorder? Only 2 of these LAIs are approved. Risperidone microspheres every 2 weeks and also our Aripiprazole once monthly. 

These have different profiles, in terms of safety. Most likely, they differ more on safety than they differ on efficacy. But it's up to the clinician and the patient to choose among them, find the right oral dose and understand whether that works for them, whether that's tolerable. And then you can move into the once-monthly injection with Aripiprazole or the biweekly injection with Risperidone.