During COVID-19, minimise unnecessary visits, and consider short term and long term management options for individuals self-isolating or symptomatic

Normal administration

The dosing interval of depot antipsychotic injections varies from 1 week to 3 months.

During COVID-19

There may be a requirement to alter the dosing interval of depot antipsychotic injections during the COVID-19 pandemic and the next section provides guidance on the available options.

Short term amendments

For most formulations and most patients, a short term, single dose delay of 1-2 weeks is unlikely to cause harm or loss in efficacy

Paliperidone

Where paliperidone monthly injection is delayed, ensure the patient receives the correct number of injections over the course of a year by actioning the following:

  • If there is a delay to the day of administration for a single month, try to revert to the original administration date the following month
  • For example, if an injection is given on 1st January, then delayed and given on 8th February, you should then attempt to regain the normal date and give again on 1st March

Long term amendments

To reduce the number of depot administrations required, take specialist advice and consider increasing the dosing interval of the depot whilst retaining the same overall dose:

  • for example, flupentixol decanoate depot injection 100mg once weekly could be given as 400mg four weekly
  • a longer dosing interval does not diminish the effectiveness of the drug as long as the overall dose remains the same

Caution

There are some cases where an increase in the dosing interval may not be appropriate i.e.:

  • the dose of a single injection is above the licensed maximum
  • the patient deteriorates around the time the injection is due
  • the patient has tried higher doses before but experienced side effects

Further examples can be found at the Royal College of Psychiatrists

Risperidone

  • Under specialist advice, risperidone 2 weekly injection can be switched to paliperidone monthly injection (Xeplion®) if GFR >50ml/min

Detailed advice on how to carry out the switch can be found at the Royal College of Psychiatrists

Paliperidone

  • Under specialist advice, paliperidone 1 monthly injection (Xeplion®) can be switched to paliperidone 3 monthly injection (Trevicta®) in stable patients who have had at least 4 months of paliperidone

Detailed advice on how to carry out the switch can be found at the Royal College of Psychiatrists

Switch from depot to oral

In some cases under specialist advice, it may be appropriate to switch a patient from a depot antipsychotic to an oral equivalent; however, this option carries an increased risk of relapse.

Detailed advice on how to carry out the switch can be found at the Royal College of Psychiatrists

Individuals with COVID-19 symptoms

For individuals with COVID-19 symptoms, recommendations are:

  • If the patient is due to have their dose administered, consider an alternative short term treatment plan. If currently psychologically well and risk of rapid relapse is considered low, consider delaying administration as per the short term guidance above.
  • If this is not possible, the depot should be given at home by someone wearing full personal protective equipment (PPE) in line with PHE guidance and the Trust’s infection control policy.
  • Ensure a clear plan is agreed and documented with patient/carer, care coordinator and the responsible consultant regarding follow up after depot administration and monitoring of physical and mental health symptoms.

Monitoring

If making any changes to a patient’s treatment, it is important to review the patient weekly after the change to ensure that they are physically and mentally well. This could be done over the phone.

Further information

General guidance on medicines management of mental health patients during COVID-19 is available from The Royal College of Psychiatrists.

Acknowledgements

This page was developed in conjunction with Professor David Taylor, Director of Pharmacy at the Maudsley Hospital and Peter Pratt, specialist mental health pharmacy advisor at NHSEI. We are hugely grateful for their input.

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