Pharmacists Champion Long-Acting Injectables for Schizophrenia

In an interview with Pharmacy Times, Michael McGuire, PharmD, delves into the crucial role pharmacists play in advocating for and implementing long-acting injectable (LAI) medications for individuals with schizophrenia. He highlights the importance of early intervention in hospital settings, leveraging manufacturer programs, and navigating complex dosing regimens. McGuire also emphasizes the pharmacist’s potential in community settings, advocating for patient education, collaboration with prescribers, and even the administration of LAIs. He further discusses the growing availability of simplified initiation options, stressing the need for pharmacists to stay informed about these advancements to ensure optimal patient care.

Pharmacy Times: How can pharmacists play a more active role in advocating for the earlier use of long acting injectables (LAIs), including collaborating with prescribers, educating patients, and addressing logistical challenges?

Michael McGuire, PharmD: I mean, I've got the benefit that I'm part of a treatment team and I help identify patients who are appropriate candidates. You know, especially in the hospital setting, again, it's a great way for a pharmacist to get involved in helping to identify appropriate patients. A lot of the manufacturers have hospital initiation programs where it's no cost to the hospital to initiate the products, so that's an opportunity for a pharmacist to get involved and help navigate those programs from their manufacturers, identifying appropriate patients, identifying patients who are appropriate candidates for them. If there's ever cases, especially in the hospital, of forced medication due to treatment refusal, a lot of times we'll use long acting injectables, and in those settings, depending upon state laws, [there is] lots of room for pharmacists to be involved identifying the right patients. And then sometimes we'll get patients who are stabilized on something, and then it comes up down kind of halfway through somebody's stay, ‘Oh, family would really like them on an injectable.’ Well, we could have identified that earlier in the hospitalization. Now we've got to change therapy because whatever they're on isn't available in an LAI. So, I think of LAIs as early as possible in a hospital setting.

And I think in a community setting, [pharmacists are] educating patients about the availability of LAIs when they're talking to patients about any of the antipsychotic agents that are available. [They are] counseling and then talking to them about those products that are available and encouraging them to consider it. And then there's an opportunity to collaborate with the outpatient provider and perhaps even administer, right there. Pharmacist administering in the community, really, I think, should be occurring commonly. Unfortunately, it's not, but it's a great way for pharmacists to get involved in caring for patients in the community.

Pharmacy Times: The availability of initiation options that allow for single-day initiation with a 1-time oral dose can simplify the process of starting LAI treatment. How can pharmacists ensure they are knowledgeable about the effectively utilize these options?

McGuire: So, again, I'll kind of reiterate the point I made earlier that there are more and more of the LAIs that are available, not just Initio and its regimen. We've got more of these now than we've ever had. Some of them are very simple. Some of them are a bit more complex. Some have multiple doses. Some have specific oral-to-LAI dose conversions. So just be knowledgeable about these products and where to go. Not a day or week goes by that I don't pull up one of these LAIs and check myself. I think it's impossible to know every single fact about every single one of them, but being part of a team, we can help make sure that we're dosing appropriately, that we're not administering in somebody who's already had one just a few weeks ago. Again, that's something that not a week goes by, that I don't track back when a long acting injectable was last administered. We have patients come into the hospital that have a reported history of an LAI, and we have to go back and find out when did when did they get it? When are they due their next one? Single dose, single day administration is great and not having to do oral overlaps. Simplicity is the best, but not all of these products are simple. So pharmacists really need to know, if they pull up a patient and they see that there's an LAI, they need to know, ‘oh, I need to go and look and see whatever it is about that product.’

I had students call about a product, and they didn't ask the right questions, and the information they got from the pharmacist was not accurate. So, they had call back and find out more because they didn't know the product like I did. Now, I don't think again that it's necessary to memorize every fact about every one of them. But they're very common. You know, we're using these more commonly than we ever have, and hopefully that's going to continue to grow. And again, we're going to get more and more of these products. So, pharmacists have got to be able to put their fingers on information quickly and know, ‘oh yeah, this is one that I need to double check and make sure we're not double loading this person.’ I've had that happen before where a patient gets loaded with 1 dose a month ago, and then they come to us, or we had loaded them, and then they go somewhere else, and they get reloaded. And then they came back to us, and so [they were] double loaded within 2 months, and unfortunately, that's a product of our fragmented health care system. So again, opportunity for a pharmacist to eyeball these meds and make sure appropriate utilization, appropriate dosing, watching for medication errors, ensuring medication errors don't happen.