Differentiating aspects of oral and long-acting injectable antipsychotic drugs for tailoring the therapy of schizophrenia in clinical practice: a narrative review

Schizophrenia is a serious psychiatric condition requiring continuous treatment with antipsychotic medications available in different formulations, including oral antipsychotics (OAPs) and long-acting injectables (LAIs). This narrative review aims to comprehensively outline the advantages and disadvantages of OAPs and LAIs to support clinicians in choosing different formulations based on the presentation of clinical symptoms. An electronic search of the PubMed database was performed in June 2024, and additional articles were retrieved from the references or personal knowledge of the authors. Relevant advantages of OAPs identified in the literature include dosing flexibility, ease of discontinuation, lower cost, autonomy of patient administration, shorter time to steady-state, and wide choice of molecules, including risk of nonadherence, plasma level fluctuations, food and drug interactions, and polypharmacy. LAIs' advantages include improved adherence leading to reduced relapse rates and hospitalizations, patient convenience, and stable drug levels while disadvantages include discomfort of injection, possible stigma, less manageable drug interactions, organization of administration centers, and patient preference possibly contrary to physician preference. When treating schizophrenia, it is critical to consider patients' needs, preferences, and history of medication adherence. Combining patient education with individualized treatment plans may optimize outcomes and improve the quality of life.