Achieving Therapeutic Plasma Concentration Levels With Oral Overlap, IM Loading Doses When Administering LAIs

Gain insights into the considerations for initiating long-acting injectable (LAI) antipsychotics and optimizing therapeutic plasma concentrations in this  Clinical Pearl video with Psych Congress NP Institute Steering Committee Member Desiree Matthews, PMHNP-BC. Matthews reviews the strategies for achieving rapid plasma concentrations with different LAIs to ensure effective treatment.

Read the transcript:

Hello, my name is Desiree Matthews, and I'm a psychiatric nurse practitioner. I work at a community mental health center in Charlotte, North Carolina.

When we consider initiating long-acting injectable antipsychotics, we need to be mindful of the need for oral overlap of our medications, or IM loading doses may be available based on the LAI that we're choosing.

For instance, if you consider risperidone microspheres, this requires a 3-week overlap of oral medication. The reason is because we want to quickly achieve therapeutic plasma concentrations with our medication. And in this case, with risperidone microspheres, in order to do that, we do need to use that oral overlap of 3 weeks.

Now, we do have paliperidone palmitate, for instance, that we are able to achieve rapid plasma concentrations at paliperidone by utilizing an injection on day 1 for a loading dose and a subsequent injection by day 8. And this again achieves that rapid plasma concentration that we need in order to become therapeutic at our plasma concentration levels.

Desiree Matthews, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.