How to Properly Manage Missed Doses of Long-Acting Injectable Medications

Get expert insights on handling missed doses of long-acting injectables (LAIs) from Psych Congress NP Institute Steering Committee Members, Desiree Matthews, PMHNP-BC, and Amber Hoberg, MSN, APRN, PMHNP-BC. In this rapid refresher, the duo explores how to tackle missed doses and follow prescribing instructions for different LAIs to ensure you are providing the best care possible for your patient with schizophrenia.

Visit the Schizophrenia Learning Library for more schizophrenia rapid refreshers, clinical pearls, and perspectives from Nurse Hoberg and other experts in the field.

Watch this video to learn more about achieving therapeutic plasma concentration levels with oral overlap and intramuscular (IM) loading doses when administering LAIs, with Hoberg and Matthews.

Read the Transcript:

Desiree Matthews, PMHNP-BC: Hello, my name is Desiree Matthews and I'm a Psychiatric Nurse Practitioner. I work at a community mental health center out of Charlotte, North Carolina.

Amber Hoberg, MSN, APRN, PMHNP-BC: My name is Amber Hoberg, I am a Psychiatric Mental Health Nurse Practitioner out of San Antonio, Texas. I work in a private practice, Morningstar Family Medicine and for the Baptist Health System.

So one of the questions that's come in is asking about long-acting injectables and missed doses, whether we miss a dose or it goes 1 month or 2 months over the time frame. How do you handle that? For me in particular, you have to go back to the product insert of each individual long-acting injectable because each one is different in regards to the grace period, as well as what you need to do as far as retitration or, can you just give the next injection?

Each one is very different in what they allow; really learning those PIs can be very helpful so that you're able to make sure that you're doing the right thing for your patient.

Desiree, in your practice, how do you handle if a patient has missed an LAI?

Matthews: You know, Amber, certainly I do the same thing.

I refer back to that product insert and really following the misdosing instructions because again, based on the time elapsed since the last injection, you may need to perhaps do a loading dose of an intramuscular (IM), maybe there's oral overlap coverage. In some cases, if the window has elapsed so long with some products, you need to completely restart from ground zero as you would with a new patient and a new start. So, I do exactly refer right back to the package insert and follow those instructions.

Hoberg: Great. Thank you so much for joining us. Stay tuned and we'll see you again next time.

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from the University of Texas Health Science Center, San Antonio. She has been working for the past 12 years with the adult and geriatric populations treating all types of psychiatric conditions. Her background, as a psychiatric advanced practice nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Med Management Associates and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.

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.

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