Depot-Depot

Switching from long acting injectables to long acting injectables with a different active substance

Instructions for switching between two depots are provided on this page.
Please exercise caution when considering a switch between depots containing different active substances (e.g., switching from olanzapine depot to paliperidone depot).
We strongly recommend initially switching to the oral form of the medication before transitioning to the depot.
Introducing a depot medication that contains a new active substance may lead to adverse events related to the new drug. Due to the long half-life of depot antipsychotics, these side effects can persist for an extended period.
Once the depot is administered, it is not possible to remove the drug from the system;
the only way to manage side effects (if possible) is to add a new medication that counteracts them, which may carry its own risks and side effects.
In addition, after administration of a new depot a new steady state will be reached after months.
It is therefore not possible to optimize dosing in relation to effect on short term.

In cases where a switch from depot to depot is unavoidable, the following protocol can be used:

Switching from or to any depot besides Risperdal Consta

• On the day you normally administer the depot you are switching from, give the maintenance dose of the depot you are switching to.
  
• Do not administer any loading doses.
  
• Example: If you are switching from 210 mg of olanzapine depot every two weeks to 100 mg of paliperidone depot (Xeplion) every four weeks, on the day you would normally give olanzapine depot, start with the maintenance dose of Xeplion (100 mg). Typically, initiating Xeplion requires loading doses on days 1 and 8; however, in this protocol, you skip those and start directly with the maintenance dose on the usual olanzapine depot administration day.'
  

Switching from or to Risperdal Consta
1. Switching from Risperdal Consta to another depot:

• Add 21 days to the date you would normally administer the Risperdal Consta injection, and on that day, give the maintenance dose of the new depot.
  
• Do not administer any loading doses.
  

2. Switching to Risperdal Consta from another depot:

• Administer Risperdal Consta 21 days before the next scheduled dose of the current depot.
  
• Do not administer any loading doses.