Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Choose, initiate and monitor long-acting injectable antipsychotics through shared decision making, match oral tolerability and product-specific loading or overlap requirements, prevent missed-dose errors, and preserve dignity, consent and physical-health surveillance.
Long-acting injectable antipsychotics release medicine over weeks or months and make exposure more predictable, but their main value depends on the person's goals. Some people prefer fewer tablets, less daily reminder of illness or clearer relapse planning. Others value the ability to stop oral medication immediately, fear needles, have experienced coercion or need privacy that clinic attendance undermines. Discuss these trade-offs explicitly. NICE recommends considering a depot or long-acting injectable after an acute episode when the person prefers it or when avoiding covert non-adherence is a clinical priority.
Choice remains pharmacological as well as practical. Review previous oral response and adverse effects, metabolic and movement risk, prolactin, cardiac history, renal and hepatic function, interactions, pregnancy and formulation licence. A depot cannot be removed after injection, so establishing tolerability is especially important. Record whether the product requires prior oral stabilisation, oral overlap, loading doses or post-injection observation. Product names, salt strengths and apparent milligrams can differ; prescribe the exact brand or formulation required by local safety systems.
The person values reduced tablet burden or predictable administration and understands that an injected dose cannot be immediately withdrawn.
Repeated oral omissions or unclear adherence has contributed to relapse, making observed long-term administration potentially useful within collaborative care.
Pain, swelling, bleeding, neurovascular symptoms or systemic reaction after administration requires documented examination and product-specific response.
Sedation, akathisia, parkinsonism, prolactin or metabolic effects may persist because the depot continues releasing medicine after treatment is changed.
A gap beyond the product window can require reloading or oral cover and must not be managed by calendar intuition alone.
Follow the alternative two-injection start and missed-dose instructions exactly when used; review CYP2D6 and CYP3A4 interactions, akathisia, impulse-control symptoms and ongoing metabolic monitoring.
Individualise within the renal-function-specific SmPC range and do not use when creatinine clearance is below 50 mL/min; also monitor prolactin, movement, metabolic and QT risks and follow missed-dose rules.
It is not a separate therapeutic relationship and should never replace explanation, consent, psychological care or attention to recovery goals.
Different salts, brands and intervals use distinct strengths and algorithms, so apparent numerical similarity does not establish dose equivalence.
Confirmed administration clarifies one part of adherence but cannot explain every relapse, response failure or missed psychosocial need.
Once injected, medicine release continues, making tolerability testing and conservative product-specific planning particularly important.
Needles and clinic procedures may recall restraint or trauma, and respectful choice of setting, clinician and pacing can improve safety.
Offering an injection as a reward for compliance or a punishment for missed tablets.
Assuming oral overlap, loading and missed-dose rules are interchangeable between products.
Giving a routine dose after a prolonged gap without verifying the re-initiation algorithm.
Recording injection attendance while neglecting metabolic, movement, sexual and subjective adverse effects.
Assuming confirmed drug exposure proves the diagnosis or explains every continuing symptom.
Allowing clinic convenience to override informed preference, dignity and least restrictive care.
Your practice draft is saved in this browser.
An adult stabilised on oral aripiprazole chooses the monthly long-acting formulation and the one-injection start. Which initiation regimen matches the product information?
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Safe administration requires a closed loop. Verify the prescription, patient, product, dose, site, needle, date of last injection and missed-dose window. Inspect the site and consider anticoagulation or bleeding risk. Maintain aseptic technique and document batch details when required. Arrange the next appointment before the person leaves and provide whom to contact for pain, swelling, severe restlessness, fever or other adverse effects. If an appointment is missed, check wellbeing and use the product algorithm before resuming.
Follow-up measures both relapse prevention and burden. Ask about symptoms, function and preferred outcomes, and monitor weight, waist, blood pressure, glucose or HbA1c, lipids, movement, prolactin effects and sexual function. Because drug release continues, adverse effects may persist after a decision to stop. Do not let a regular injection replace CBT, family work, substance support, physical care or vocational goals. Revisit whether the formulation still matches informed preference at every major review.