Considering Oral Overlap Requirements When Initiating LAIs
What factors should clinicians keep in mind when prescribing overlapping oral and long-acting injectable (LAI) antipsychotics? In the final part of this series on how advanced practice providers (APPs) can most effectively utilize antipsychotics for the treatment of schizophrenia, Psych Congress NP Institute Faculty Member, Hara Oyedeji, APRN, PMHNP-BC, MSEd, offers guidance to clinicians navigating LAI initiation while considering oral overlap requirements. In this insightful discussion, Oyedeji highlights the benefits of leveraging LAIs for early intervention, touches on establishing tolerability through oral agents, and discusses dosing considerations to help clinicians create effective, personalized treatment plans for their patients.
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Read the Transcript
Hara Oyedeji, APRN, PMHNP-BC, MSEd: Hello, my name is Hara Oyedeji. I am a psychiatric nurse practitioner out of Baltimore, Maryland, and I have my Master of Science in Nursing and also a Master of Science in Education, so I am an educator first and foremost. I have my own group practice, Fortitude Wellness Group, and I absolutely love being able to interact, teach, and work with fellow nurse practitioners.
Psych Congress Network: When selecting and initiating an LAI antipsychotic, how important is it to consider oral overlap requirements—and what guidance can you offer APPs to optimize dosing strategies while minimizing safety and medico-legal risks?
Oyedeji: I am a huge advocate and proponent for long-acting injections. When we're treating patients who are living with schizophrenia, we're really up against the clock, but we have to know what we're doing. Oral agents definitely play a role. We're prescribing those oral antipsychotics, but if you're thinking about initiating an LAI, you definitely want to first and foremost establish a tolerance. Know what LAI might fit that patient, and if they're already on an oral agent, are they tolerating it? Is it effective, is there an LAI formulation for that? You really need to think about your patient, making sure that they don't have any kind of adverse hypersensitivity, so to speak. And you have to establish that orally first.
Once you've gotten past that, you want to figure [out] if there's an LAI formulation that's going to work, [and] you want to go with that [formulation]. There shouldn't be a reason why we're not offering LAIs for our patient, not necessarily reserving it just because they're in a worse state than where they are. We need to start thinking proactively. The sooner we can do that, it's early intervention and we're able to actually help our patients preserve brain matter, help them gain or rather keep more time on hand because we can keep those symptoms down. You want to think about level of adherence: Is this a patient that can definitely benefit, if it's their preference, from use of an LAI?
So there's a lot of different things to think about, and if you're having oral overlap, is there a necessity really to have them on additional oral agents? It might be; it depends on the patient that you have. However, if an LAI is available, we definitely should be considering that and offering it up to our patients as soon as possible. And of course, follow your prescribing guidelines. Consider: is tapering or cross-tapering necessary if you're going to do a complete switch? Also think about, what are the other medications the patient is taking?
Hara Oyedeji, APRN, PMHNP-BC, MSEd, is a board-certified psychiatric nurse practitioner currently working in outpatient care with experience in inpatient and psychiatric hospital settings. She serves as owner, clinician and clinical preceptor in her private group practice, Fortitude Wellness Group, and is the Chief Operating Officer and Medical Director of a CARF accredited Outpatient Mental Health Clinic, Greater Chesapeake Health and Wellness in Baltimore City. Hara completed her undergraduate degree at Rutgers University and her Master’s degree in education from Monmouth University in New Jersey. She completed her Master’s degree in nursing from the University of Maryland with her Post-Master's training as a psychiatric mental health nurse practitioner from Drexel University.
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