LAI Side Effect Monitoring Tracker
Track Your Monitoring Schedule
Select your long-acting injectable (LAI) and injection date to see what monitoring is required.
Your Monitoring Schedule
Tip: These checks are required by clinical guidelines to prevent serious side effects. Bring this schedule to your appointments.
Important: Missing required monitoring can lead to serious health complications.
When someone with schizophrenia starts on a long-acting injectable (LAI) antipsychotic, it’s often seen as a win. No more daily pills. Fewer relapses. More stability. But here’s the quiet truth: every injection comes with a hidden checklist of physical risks that most clinics are missing.
What Long-Acting Injectables Actually Do
Long-acting injectables aren’t magic. They’re drugs like paliperidone, aripiprazole, and olanzapine, packed into slow-release forms that last anywhere from 2 to 12 weeks. They’re given as shots - usually in the butt or arm - and slowly leak into the bloodstream. For people who struggle with daily pills, this can mean the difference between staying out of the hospital and ending up back there. But here’s the catch: just because the drug is slow doesn’t mean its side effects are. In fact, the longer the drug stays in your body, the more time it has to quietly damage your metabolism, your movement system, and even your heart.The Monitoring Gap Nobody Talks About
A 2021 audit of 5,169 patients on LAIs across 62 UK mental health services found something shocking: only 45% had any documented side effect check in the past year. That means more than half the people getting these shots weren’t being monitored for the very things that could kill them. Weight gain? Check. Blood sugar spikes? Check. High blood pressure? Check. Movement disorders like tardive dyskinesia? Also check. Yet, in those same clinics, only 38% had their weight recorded, 32% had their blood pressure taken, and a terrifying 15% got any metabolic blood tests at all. This isn’t about laziness. It’s about system failure. Most appointments are 15 minutes long. The clinician’s job is to ask, “How are you feeling mentally?” - and if the answer is “better,” they move on. The physical side effects? They’re invisible unless someone is actively looking for them.Not All LAIs Are the Same - And Neither Are Their Risks
You can’t treat all long-acting injectables the same. Each one has its own danger zone.- Olanzapine (Zyprexa Relprevv) has a black box warning. After every injection, you must be watched for three full hours. Why? Because some people suddenly go into a deep sedation or delirium - and it can be fatal. This isn’t rare. There are documented deaths tied to skipping this step.
- Paliperidone (Invega Sustenna) causes weight gain in most patients - an average of 4.2 kg in just six months. It also spikes prolactin, which can shut down sex drive, cause breast growth in men, and stop periods in women. Regular blood tests for prolactin and glucose are non-negotiable.
- Aripiprazole (Abilify Maintena, Aristada) is better for weight and blood sugar, but it’s notorious for akathisia - that restless, can’t-sit-still feeling. It’s so common, up to 25% of users get it. Left unaddressed, it drives people to quit their meds.
- Haloperidol (Haldol Decanoate), the old-school option, still gets used. It causes movement disorders in 30-50% of patients. That’s more than half. The Abnormal Involuntary Movement Scale (AIMS) needs to be done every three months - not once a year, not never.
What Should Be Checked - And How Often
Here’s the bare minimum every patient on an LAI deserves:- Before every injection: Blood pressure, heart rate, temperature, and weight. Ask about movement problems, sexual side effects, and whether they’ve been feeling unusually tired or confused.
- Every 3 months: Full AIMS test to check for tardive dyskinesia. This isn’t optional. It’s a neurological exam that takes 5 minutes. If you’re not doing it, you’re missing early signs of permanent damage.
- Every 6 months: Fasting blood sugar, cholesterol, and triglycerides. Metabolic syndrome doesn’t show up in a mental health check. It shows up in lab results.
- Annually: Liver function, kidney function, and prolactin levels (for paliperidone and risperidone). Some side effects take months to build up. You need to catch them before they’re irreversible.
Why Clinicians Are Falling Short
It’s not that doctors don’t care. It’s that the system doesn’t reward them for doing the right thing. In community clinics, therapists are paid by the minute. Insurance doesn’t reimburse for checking blood pressure or asking about weight gain. It only pays for “psychiatric evaluation.” So, the physical risks get pushed to the bottom of the list. A 2023 survey of 200 mental health nurses found that 78% only looked for immediate injection reactions - redness, swelling, pain. They rarely asked about sexual dysfunction, fatigue, or tremors. Sixty-two percent said they weren’t trained to recognize early signs of neuroleptic malignant syndrome - a rare but deadly condition that can strike without warning. And patients? They don’t know to ask. Many think, “If it’s not hurting my head, it’s fine.” One patient on Reddit wrote: “I gained 30 pounds on Invega Sustenna. No one checked my blood sugar until I passed out at work.”
What’s Changing - And What’s Coming
The tide is turning. In 2024, 35 Medicare Advantage plans started tying payments to LAI monitoring metrics. If a clinic doesn’t document weight checks or metabolic panels, they get paid less. That’s starting to change behavior. Digital tools are helping too. New apps let patients log side effects between visits - nausea, restlessness, sleep changes. One pilot study showed a 30% jump in side effect detection just by using these tools. And research is moving fast. A blood test that predicts who’s likely to gain weight on LAIs is in phase 2 trials. If it works, doctors could avoid high-risk drugs for vulnerable patients before they even start. The International Consortium on Schizophrenia Outcomes just released a 2024 consensus statement calling for global standardization of LAI monitoring. Implementation starts in 2026. That’s not soon enough - but it’s a start.What Patients and Families Can Do
If you or someone you love is on a long-acting injectable:- Ask for a copy of the injection protocol. Does it include weight, blood pressure, and blood tests?
- Request the AIMS test every three months. If they say they don’t do it, ask why.
- Keep your own log: weight, sleep, energy, movement, sex drive. Bring it to every visit.
- If you’re gaining weight or feeling restless, don’t wait. Say it out loud. Say, “I think this shot is hurting my body.”
The Bottom Line
Long-acting injectables save lives. But they can also silently destroy them - if no one is watching. The data is clear: monitoring is the missing link. Without it, LAIs become a gamble. With it, they become a tool for real, lasting recovery. It’s time to stop treating these shots like a simple fix. They’re complex medical interventions - and they demand complex care.Do long-acting injectables cause weight gain?
Yes, some do - and it’s one of the most common and dangerous side effects. Paliperidone (Invega Sustenna) and olanzapine (Zyprexa Relprevv) are especially linked to weight gain, with patients gaining an average of 4 to 8 kg in six months. This increases risk for diabetes, heart disease, and high blood pressure. Not all LAIs cause this - aripiprazole has a much lower risk - but if you’re on one that does, regular weight checks and metabolic blood tests are essential.
How often should I get blood tests on a long-acting injectable?
At minimum, get fasting glucose and lipid panels every 6 months. If you’re on paliperidone, risperidone, or olanzapine, you should also get prolactin levels checked every 6 to 12 months. For those with existing diabetes, obesity, or heart disease, your doctor should check these every 3 months. These tests don’t show up in mental health visits - you have to ask for them.
Is it safe to skip the 3-hour monitoring after olanzapine injection?
No. Olanzapine long-acting injectable (Zyprexa Relprevv) carries a FDA black box warning for post-injection delirium/sedation syndrome. This can cause sudden confusion, extreme drowsiness, or even cardiac arrest within hours of the shot. The 3-hour observation window is mandatory. Skipping it has led to documented deaths. No exceptions.
What is AIMS testing, and why is it important?
AIMS stands for Abnormal Involuntary Movement Scale. It’s a simple 10-minute exam where a clinician watches for uncontrolled movements - lip smacking, tongue thrusting, finger tapping - signs of tardive dyskinesia. This condition can be permanent. It’s most common with older antipsychotics like haloperidol, but it can happen with any LAI. It must be checked every 3 months. If your provider doesn’t do it, ask why.
Can long-acting injectables cause permanent damage?
Yes, if side effects go unchecked. Tardive dyskinesia can become permanent. Uncontrolled weight gain can lead to type 2 diabetes and heart failure. High prolactin can cause osteoporosis and infertility. These aren’t theoretical risks - they’re documented outcomes. Regular monitoring isn’t just good practice - it’s a way to prevent irreversible harm.
Why don’t doctors monitor side effects more often?
Time and money. Most appointments are only 15 minutes long. Insurance doesn’t pay for checking weight, blood pressure, or blood sugar - only for “mental health evaluation.” So doctors prioritize mood and behavior over physical health. It’s not negligence - it’s a broken system. But that doesn’t mean you can’t push back. Ask for the checks. Bring your own records. Be your own advocate.
