SAFE AND EFFECTIVE USE OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS

To advocate for the development and implementation of standardized, pharmacist-led processes to ensure the safe, effective, and coordinated use of long-acting injectable (LAI) antipsychotics across the continuum of care; further,

To advocate for a centralized health information exchange that collects real-time and standardized information of LAI antipsychotic administrations accessible to all healthcare providers engaged in the care of the patient; further,

To collaborate with key stakeholders on the development of best practices for the safe use and management of LAI antipsychotics, regardless of site of care.

Rationale

Long-acting injectable (LAI) antipsychotics offer improved adherence, reduced relapse and hospitalization rates, and more consistent therapeutic drug levels with clear accountability for treatment engagement. However, their use may be limited by access barriers, clinician training or experience, as well as prescribing biases that reserve LAIs for patients with documented nonadherence rather than incorporating them as a proactive treatment option. System-level challenges include limited access, difficulty obtaining reimbursement, and fragmented care pathways that disrupt continuity and follow-up. Because this class of medications often lacks standardized protocols for administration, documentation, and monitoring, patients may receive duplicated doses, missed doses, or incorrect formulations, particularly during transitions of care. Variability in prescribing practices, inadvertent switching of medications from initiation to maintenance regimens, irregular dosing intervals, and non-standardized documentation across care settings further complicates the use of these medications.

Integrating pharmacists into the administration process of LAIs has expanded access and improved safety. Patients with schizophrenia and related chronic conditions often require sustained therapy to prevent relapses and support recovery. Pharmacists are essential to optimizing care with long-acting injectable (LAI) antipsychotics. They administer injections, educate patients and providers, support medication adherence, monitor for side effects, and coordinate care. By serving as accessible points of contact, pharmacists help address barriers such as needle anxiety and limited access. Their active involvement enhances adherence and clinical outcomes, reduces hospitalizations, and expands treatment access—particularly in community pharmacy settings and through home-based services. The implementation of a standardized state or national LAI database similar to state PDMPs, is critical as it would  centralize documentation from various settings, align dosing schedules, and offer clinicians real-time access to administration histories. Adopting this approach will enhance patient safety, reduce dosing errors, and facilitate greater pharmacist involvement in interdisciplinary care, consistent with ASHP’s commitment to promoting medication management continuity and data interoperability for patient care.