From the Guidelines
Withholding Azstarys and administering multiple intramuscular injections of antipsychotics is not an appropriate treatment approach for ADHD. The use of high-dose, multiple antipsychotics, such as Latuda, Zyprexa, Haldol, and Thorazine, particularly in a patient with a primary diagnosis of ADHD, is not a standard or recommended treatment approach 1. According to the practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults, stimulants, such as Azstarys, are a known psychotomimetic for individuals with schizophrenia, and should not be used in patients with an Axis I diagnosis of schizophrenia, psychosis NOS, or manic episodes with psychosis 1.
- Contraindications for stimulant use: The package inserts for stimulants, such as Azstarys, list contraindications, including concomitant use of MAO inhibitors, psychosis, glaucoma, existing liver disorder or abnormal liver function test results, and drug dependence 1.
- Antipsychotic polypharmacy: Antipsychotic monotherapy, either with clozapine or non-clozapine antipsychotics, should be strived for with most patients, as generally monotherapies incur less health service costs to society and give a lower overall risk for adverse effects 1.
- Treatment approach: The prescriber needs to develop a treatment and monitoring plan, educate the patient and family, obtain assent/consent, and then implement the treatment trial as described under the principles above 1.
The administration of multiple intramuscular injections of antipsychotics, especially without apparent consideration for the patient's underlying condition or potential adverse effects, warrants immediate review and investigation. A clear rationale for using medication combinations is necessary, and the use of medication combinations should be based on empirical evidence and not on theories about central nervous system functioning or clinical correlates of hypothesized neurotransmitter abnormalities 1.
From the Research
Administration of Antipsychotics for ADHD
- The administration of multiple intramuscular injections of antipsychotics, including Latuda (lurasidone), Zyprexa (olanzapine), Haldol (haloperidol), and Thorazine (chlorpromazine), for Attention Deficit Hyperactivity Disorder (ADHD) is not a standard treatment approach 2.
- Azstarys (serdexmethylphenidate and dexmethylphenidate) is a prescribed medication for ADHD, and withholding it to administer antipsychotics may not be appropriate.
Intramuscular Injections
- Intramuscular (IM) injections have been a part of drug administration in nursing practice for almost half a century, but there are conflicting practices that warrant investigation 3.
- The choice of injection route, including IM, intravenous (IV), and subcutaneous (SC), depends on various factors, including safety, efficacy, patient preference, and pharmacoeconomics 4.
Patient Preferences and Adherence
- Patient preferences for characteristics of long-acting injectable antipsychotic agents, such as route of administration and dosing interval, are important considerations in treatment decisions 5.
- Medication adherence is crucial for the success of treatment, and non-adherence can be costly for the health service 6.
Treatment of Schizophrenia
- Long-acting injectable (LAI) formulations of antipsychotics, such as paliperidone, aripiprazole, olanzapine, and risperidone, are available for the treatment of schizophrenia 2.
- These formulations can enhance patient adherence, but barriers to their use remain, and education of patients and clinicians is important for their effective use 2.