The Promise and Challenges of Long-Acting Medicines in Long-Term Health

Overview

Long-acting medicines release a drug gradually into the bloodstream, enabling monthly or less frequent dosing for chronic conditions. This could simplify treatment, reduce missed doses, and improve long-term management for millions of people.

Original publisher: The Conversation

• Long-acting medicines can reduce how often patients need to take medicines, easing adherence and potentially cutting missed doses.
• Missed doses with antibiotics can drive treatment failure and antimicrobial resistance, underscoring the value of sustained-release options.
• UK NHS costs and waste from unused prescriptions and packaging are concerns that long-acting therapies could help address.
• Recent HIV prevention and treatment advances show long-acting cabotegravir injections replacing daily tablets for PrEP and therapy, with injections every two months after initial doses.

The author is The Conversation.

Introduction

The article discusses how long-acting medicines, designed to release a drug gradually, can change the way chronic conditions are treated. By enabling injections or infrequent dosing, these therapies may reduce the burden of daily medication and help people stay on treatment, potentially improving outcomes and reducing healthcare resource use.

Benefits of Long-Acting Medicines

For many long-term conditions, taking medicines daily or with multiple doses can be challenging. Long-acting formulations offer the possibility of less frequent dosing, which can simplify regimens, lower the chances of missed doses, and improve adherence. In some contexts the medicines stay active in the body between doses, helping maintain disease control without daily administration.

Missed Doses and Antimicrobial Resistance

Missed doses can have serious consequences. With antibiotics, failing to follow prescriptions can contribute to treatment failure and antimicrobial resistance, a growing global health threat. Antimicrobial resistance arises when bacteria adapt in ways that reduce drug effectiveness, and it is associated with millions of deaths worldwide. The article highlights that resistance is making antibiotic development harder and more expensive, underscoring the potential public health value of long-acting options that reduce non-adherence.

Waste, Costs, and Access

Missed doses also create waste—unused prescriptions and packaging contribute to costs and environmental impact. In the UK, unused prescriptions are estimated to cost the NHS over £300 million annually. Blister packs and other packaging can generate waste that is not easily recyclable through regular recycling streams. Long-acting therapies could mitigate some of this waste by simplifying treatment and reducing the number of individual doses.

HIV PrEP and Long-Acting Treatments

Recent advances in HIV prevention and treatment demonstrate the practical potential of long-acting medicines. NHS England announced the rollout of long-acting cabotegravir injections for HIV prevention in high-risk groups who cannot take daily oral PrEP. In 2025, NICE recommended cabotegravir as a PrEP option for this group. After the initial doses, injections are given every two months, providing an alternative to daily tablets. Cabotegravir is also used in HIV treatment regimens in combination with rilpivirine, with injections every two months after the initial doses, helping maintain viral suppression between doses. Ongoing research suggests long-acting injectable regimens can improve viral control for some patients who struggle with daily adherence.

Adoption, Access, and Research Ecosystem

Successful deployment depends on clinician willingness to prescribe long-acting medicines and patient acceptance. Global studies indicate many healthcare providers are open to prescribing effective long-acting therapies, and patients show strong interest in alternatives to daily tablets. The Liverpool-based UK Hub for Advanced Long-acting Therapeutics (Halo) is coordinating research and stakeholder engagement to explore which diseases could benefit from long-acting approaches and what patients would be willing to use. The article emphasizes that long-acting medicines will not replace every tablet or inhaler, and patient choice must stay central. Cost, access to clinics, and follow-up requirements may influence practicality in real-world settings.

Conclusion

Long-acting medicines hold promise for improving treatment adherence, reducing disease progression, and cutting waste in long-term care. Realizing this potential will require collaboration among clinicians, researchers, policymakers, and patients, with careful consideration of individual needs and health system constraints.