Table 6.

Management Strategies for Common Adverse Effects of LAIs

Adverse effect	Management strategies
Drug-induced Parkinsonism (DIP)	Reduce LAI dose; switch to lower-risk antipsychotic (clozapine, quetiapine); add amantadine; consider anticholinergic (short-term)
Sedation	Reduce dose if possible; switch to less-sedating antipsychotic (aripiprazole, paliperidone)
Insomnia	Optimize timing of concomitant medications; sleep hygiene training; CBT-I; consider short-term hypnotic
Clinical evidence of prolactin elevation	Reduce LAI dose; switch to prolactin-sparing antipsychotic (aripiprazole, olanzapine); add adjunctive aripiprazole
Akathisia	Reduce LAI dose; switch to lower-risk antipsychotic; use adjunctive medication (vitamin B6, mirtazapine, or an anticholinergic) until dose reduction or switching LAI is completed
Injection site reactions	Local symptomatic treatment (ice, heat, or topical steroid); proper injection technique (site rotation, needle size); avoid massaging injection site