Is this LAI antipsychotic (e.g., Uzedy) an aripiprazole, risperidone or paliperidone product?

Aristada, Asimtufii, Consta, Hafyera, Initio, Maintena, Perseris, Rykindo, Sustenna, Trinza, Uzedy—which are which?

Here are my medication mascots for aripiprazole, risperidone, and paliperidone. Association of a drug with a mascot is a visual mnemonic technique that enables recollection of many associated facts—in this case, whether the long-acting injectable (LAI) antipsychotic an aripiprazole, risperidone or paliperidone product.

This is the same memory technique used in Cafer's Psychopharmacology: Visualize to Memorize 270 Medication Mascots to distinguish the amphetamines from the methylphenidates. Amphetamine products include an amplifier while those representing methylphenidate products include a Scantron sheet ("Write-a-line" on "Math final date").

Here are the 3 principal mascots for risperidone, paliperidone, and aripiprazole. Antipsychotics are generally represented by spooky characters. They're cringeworthy but effective, at least for me.

After memorizing the 3 main mascots, learn the following pictures and you will know whether, e.g., Uzedy, is an aripiprazole, risperidone or paliperidone product.

Risperidone long-acting injectable (LAI) products:

1. Consta

2. Rykindo

3. Perseris

4. Uzedy

Paliperidone LAI products:

1. Sustenna

2. Trinza

3. Hafyera

Aripiprazole LAI products:

1. Maintena

2. Asimtufii

3. Aristada

4. Initio

I had trouble with the spelling of Maintena and Sustenna concerning one vs two N's. Is it Maintena or Maintenna? Sustena or Sustenna? The correct spelling for each is 8 letters: MAIN-TENA and SUST-ENNA.

In Cafer's Psychopharmacology: Visualize to Memorize 270 Medication Mascots, the LAI antipsychotic comparison tables are located on the last page of the green-tabbed sections— Green for antipsychotics, because hallucinations and delusions of "little green men" are signs of psychosis.

Risperidone and Paliperidone products

Medication	​Strength	​Dosage	​PO Overlap	​Pain	​Max	​Route / Site	​Details
​RISPERDAL CONSTA (risperidone)	​12.5 mg 25 mg 37.5 mg 50 mg	​q 2 wk	​3 wk	​No	​50 mg q 2 wk	​IM gluteal or deltoid	Usual starting and maintenance dose is 25 mg q 2 wk.
​RYKINDO (risperidone)	​​12.5 mg 25 mg 37.5 mg 50 mg	​​q 2 wk	​3 wk	No	50 mg q 2 wk	IM gluteal or deltoid	​Equivalent to RISPERDAL CONSTA
​PERSERIS (risperidone)	​ 90 mg 120 mg	​q 4 wk	​None needed	Yes	​120 mg q 4 wk	​SC abdomen	​It's like an injectable implant. Thick 18-gauge needle, leaves a hard palpable lump.
​UZEDY (risperidone)	​50, 75, 100, 125, 150, 200, 250 mg	​q 4–8 wk	​​None needed	​?	​250 mg q 2 mo	​SC abdomen or upper arm	​Therapeutic blood levels are reached within 6 to 24 hr.
​INVEGA SUSTENNA (paliperidone palmitate)	​39 mg 78 mg 117 mg 156 mg 234 mg	​q 4 wk	Optional	​No	​234 mg monthly	​IM with first 2 injections in deltoid for faster distribution, with subsequent injections deltoid or gluteal.	​Standard dose is 234 mg once, then 156 mg on day 8 (with window of day 4 – day 12), then 117 mg monthly thereafter. Gradual rise to maximum serum concentration (Cmax) at 13 days.
​INVEGA TRINZA (paliperidone palmitate)	​273 mg 410 mg 546 mg 819 mg	​q 3 mo	​N/A— transition from Sustenna	​No	​819 mg q 3 mo	​IM gluteal or deltoid	​Must first have received four monthly Sustenna injections, and the last two Sustenna doses must be the same strength.
INVEGA HAFYERA (paliperidone palmitate)	​1092 mg 1560 mg	​q 6 mo	​N/A— transition from Trinza	No	​1560 mg q 6 mo	​IM gluteal	​Must first have received four monthly Sustenna injections or one Trinza injection.

Dose equivalents / conversions between risperidone and paliperidone products

Aripiprazole products

Medication	​Strength	​Dosage	​PO overlap	​Pain	​Max	Route/site	Details
​ABILIFY MAINTENA (aripiprazole)	​300 mg 400 mg	q 2 mo	​2 wk	No	​400 mg monthly	​IM deltoid or gluteal	​The label recommends starting and maintenance dose of 400 mg/mo unless the patient is a 2D6 poor metabolizer (10% of population) or taking a strong 2D6 or 3A4 inHibitor (then start 300 mg).
​ABILIFY ASIMTUFII (aripiprazole)	​720 mg 960 mg	q 2 mo	​2 wk	No	960 mg q 2 mo	​IM deltoid or gluteal	​The label recommends starting and maintenance dose of 960 mg every 2 months unless the patient is a 2D6 poor metabolizer (10% of population) or taking a strong 2D6 or 3A4 inHibitor (then start 720 mg q 2 mo). It is recommended to back down to 720 mg if side effects occur. May give up to 2 weeks before or 2 weeks after the 2-month scheduled timepoint.
​ARISTADA (aripiprazole lauroxil)	​441 mg 662 mg 882 mg 1064 mg	​q 4–8 wk*	3 wk (unless co-admin-istered with Initio)	​Yes	​882 mg monthly	​IM gluteal (441 may be deltoid)	​ Must shake forcefully and inject immediately and rapidly so microcrystals do not clog the needle. *Given q 4 wk, other than the 882 mg strength which is q 4–6 wk, or the 1064 mg which is q 8 wk (equivalent to 882 mg q 6 wk). If changing from Maintena to Aristada, give the first Aristada injection 2 to 3 wk after the last Maintena injection.
​ARISTADA INITIO (aripiprazole)	675 mg	once	​Single 30 mg PO dose	​Yes	​675 mg once	​IM deltoid	​On the same day, give aripiprazole 30 mg PO x 1, Initio injection x 1, and the first Aristada injection (or within 10 days). Tolerability to aripiprazole must first be established—in clinical trials this was done with aripiprazole 5 mg PO x 2 days, then on day three, 30 mg PO + Initio 675 mg (deltoid) + Aristada 1064 mg (gluteal), to repeat Aristada 1064 mg q 2 mo).

Dose equivalents / conversions between aripiprazole products

The other antipsychotic LAIs

Medication	Strength	Dosage	PO overlap	Pain	Max	Route/Site	Details
HALDOL DECANOATE (haloperidol)	​Usually 100 mg or 200 mg but can custom- ize dose from vial	​q 4 wk (q 2–4 wk) IM	1–3 wk	​Yes	​450 mg monthly (too high)	​Gluteal is preferable, but deltoid is acceptable.	​Traditionally given with 1–3 wk PO overlap, with a maximum of 100 mg for the first injection. If > 100 mg is needed, give the balance in 3–7 days if no EPS. According to Ereshefsky (1993) it can be given without a PO overlap if the loading dose of the LAI equals 20x the total daily PO dose. Subsequent monthly injections are typically 10–15 x the oral daily dose. 200 q 4 wk is equivalent to 14–20 PO QD, which is anticipated to produce a serum haloperidol level of 5–12 ng/mL. The FDA max of 450 mg/mo (equivalent to 30–45 mg PO daily) carries significant risk of tardive dyskinesia, so try not to exceed 200 mg of the LAI monthly (unless serum levels are lower than anticipated). Consider 25% dose decrease about every 3 months because it tends to accumulate.
​PROLIXIN DECANOATE (fluphenazine)	​12.5 mg 25 mg 50 mg 100 mg	​q 3–6 wk IM or SC	​0–7 days	​Yes	​100 mg q 3 wk (too high)	​​Gluteal is preferable, but deltoid is acceptable.	​Start 12.5 mg q 3 wk (roughly equivalent to 10 mg PO daily) or 25 mg q 3 wk. Onset of effect is within 24–72 hours. A realistic max dose is 50 mg q 3 wk or 100 mg q 6 wk, either of which is roughly equivalent to 40 mg PO daily.
​ZYPREXA RELPREVV (olanzapine)	​150 mg 210 mg 300 mg	​q 2–4 wk IM	​None needed	​No	​300 mg q 2 wk	​Gluteal	​Black box warning of post-Injection delirium/sedation syndrome (PDSS) of olanzapine overdose which can lead to coma, likely due to intravascular injection. Patients must be observed for at least 3 hours post-injection in a registered facility. Risk of PDSS is about 0.07% (about 1 in 1400 injections), with patients recovering within 72 hours.

Cafer's Psychopharmacology: Memorize 270 Medication Mascots (formatted PDF)

Buy Now