Tolerability Testing in Long-Acting Injectable Prescriptions

Do clinicians need to test for tolerability before prescribing a long-acting injectable (LAI)?

In this video, Desiree Matthews, PMHNP-BC,  and Amber Hoberg, MSN, APRN, PMHNP-BC delve into the essential practice of tolerability testing before prescribing LAIS. They highlight the importance of ensuring patient safety and treatment efficacy in mental health care decisions.

Read the transcript:

Desiree Matthews, PMHNP-BC: Hello, my name is Desiree Matthews and I'm a Psychiatric Nurse Practitioner. I work at a community mental health center out of Charlotte, North Carolina.

Amber Hoberg, MSN, APRN, PMHNP-BC: My name is Amber Hoberg, I am a Psychiatric Mental Health Nurse Practitioner out of San Antonio, Texas. I work in a private practice, Morningstar Family Medicine and for the Baptist Health System.

Nurse Matthews: One of the questions we received is regarding, do we need to test for tolerability before giving a long-acting injectable? And yes, we do. We need to test for hypersensitivity and a true allergic reaction before giving that LAI. In some cases, we do have history of patient taking the certain molecule. For instance, if it's a risperidone-containing product, if they've taken risperidone and tolerated it well, I can go ahead and give the long-acting injectable. If they are drug-naive, certainly test for tolerability, and that can vary based on the clinician's judgment. In one trial for aripiprazole lauroxil, these were treatment-naive patients were given 2 days of oral aripiprazole, but for more in-depth evaluation you may want to do more than 2 days. What about you, Amber?

Nurse Hoberg: I do the exact same thing. Yes, you want to make sure that you are testing for hypersensitivity and adverse reactions. The reason why is because once you give these injections, they last a certain period of time and you can't take that back. So making sure that we do test for these things is very important and, again, how long of a length of time is going to be dependent on you, your practice, and your comfort level. Some people might think a day or two is appropriate. Some may think a week or more might be appropriate as well. So really it's their comfort level with how they manage that.

Nurse Matthews: And the patients too, right? They may be comfortable with waiting a week or two and then coming back to receive that LAI when accept and feel confident and really believe in their treatment plan.

Nurse Hoberg: Thank you so much for joining us. Stay tuned and we'll see you again next time.

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from the University of Texas Health Science Center, San Antonio. She has been working for the past 12 years with the adult and geriatric populations treating all types of psychiatric conditions. Her background, as a psychiatric advanced practice nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Med Management Associates and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.

Desiree Matthews, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.