Pharmacological treatment is central to effective management of
schizophrenia. Prescribing clinicians have an increasing array of options from which to choose, and oral
antipsychotic polypharmacy is common in routine clinical practice. Practice guidelines recommend long-acting
injectable (LAI) formulations, typically viewed as monotherapeutic alternatives, for patients with established nonadherence. Yet there are limited data on the prevalence and nature of concurrent oral
antipsychotic prescriptions in patients receiving LAIs. Our observational, claims-based study examined the frequency and duration of concurrent oral prescriptions in 340 Medicaid patients receiving LAI
therapy. Specifically, we examined patients with a recent history of nonadherence and hospitalization for
schizophrenia and included both first-generation
antipsychotic depot medications (
fluphenazine decanoate,
haloperidol decanoate) and more recently available second-generation
injectables (LAI
risperidone,
paliperidone palmitate). Of all patients initiated on LAIs, 75.9% had a concurrent oral
antipsychotic prescription in the 6 months post-hospital discharge. Patients receiving concurrent prescriptions were frequently prescribed an oral formulation of their LAI agent, but many first-generation LAI users received a concurrent second-generation oral medication. The lowest rate of concurrent prescribing (58.8%) was found with
paliperidone palmitate, whereas the highest rate was with LAI
risperidone (88.9%). Overlap in oral and LAI prescriptions typically occurred for a substantial period of time (ie, >30 days) and for a notable percentage of the days covered by LAIs (often 50% or more). Our findings highlight the need to further examine such prescribing patterns, to probe the reasons for them, and to clarify the optimal roles of different
antipsychotic treatments in clinical practice.