From the Guidelines
Withholding Azstarys for ADHD and administering multiple intramuscular injections of antipsychotics is not an appropriate treatment approach. The use of high-dose, multiple antipsychotics, particularly in a patient with a primary diagnosis of ADHD, is not a standard or recommended treatment approach, as stated in the guidelines for the treatment of ADHD 1.
Key Considerations
- Stimulants, such as Azstarys, are considered first-line therapy for ADHD 1, and their use is supported by evidence-based practice parameters 1.
- Antipsychotics, such as Latuda, Zyprexa, Haldol, and Thorazine, are not typically used as a first-line treatment for ADHD and may even exacerbate the patient's condition, particularly if they have a history of psychosis or other contraindications 1.
- The administration of multiple intramuscular injections of antipsychotics without consideration for the patient's underlying condition or potential adverse effects is a concern and may lead to serious adverse events, such as increased risk of sudden cardiac death, hallucinations, and other psychotic symptoms 1.
Recommendations
- Azstarys should not be withheld without a valid medical reason, and alternative treatment approaches should be considered in consultation with a qualified healthcare professional.
- A thorough evaluation of the patient's medical history, including any contraindications or potential interactions with other medications, should be conducted before initiating any new treatment.
- The use of antipsychotics in patients with ADHD should be carefully considered and monitored, with regular assessments of the patient's condition and potential adverse effects 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Administration of Azstarys and Antipsychotics
- The prescribed medication Azstarys (serdexmethylphenidate and dexmethylphenidate) is used to treat Attention Deficit Hyperactivity Disorder (ADHD) 2.
- Withholding Azstarys and instead administering multiple intramuscular injections of antipsychotics, including Latuda (lurasidone), Zyprexa (olanzapine), Haldol (haloperidol), and Thorazine (chlorpromazine), may not be appropriate as it could potentially exacerbate the patient's condition.
Intramuscular Injections
- Intramuscular (IM) injections have been a part of nursing practice for almost half a century, but there are conflicting practices that warrant investigation to determine their effectiveness 2.
- The administration of IM injections involves several factors, including injection sites, needle selection, volume administered, and injection techniques 2, 3.
- Patient and healthcare professional preferences for characteristics of long-acting injectable antipsychotic agents, such as route of administration and injection location, should be considered 4.
Choice of Medication Administration Route
- The optimal choice of medication administration route, including intravenous, intramuscular, and subcutaneous injection, depends on several factors, including safety, efficacy, patient preference, and pharmacoeconomics 5.
- Clinicians should consider patient characteristics, medication administration-related factors, and healthcare staff/institution-related factors when deciding on the injection route 5.
- Long-acting injectable second-generation antipsychotics, such as paliperidone, aripiprazole, olanzapine, and risperidone, are available and have demonstrated superiority over placebo and are comparable to their oral counterparts in terms of safety and tolerability 6.
Effective Administration of Intramuscular Injections
- Nurses should be up to date with the evidence on factors such as selection of injection site, use of appropriate equipment, and injection technique to ensure effective administration of IM injections 3.
- The evidence on effective administration of IM injections can enhance nurses' decision-making and technique when undertaking this procedure 3.