82 - Other LAI aripiprazole brands

Other LAI aripiprazole brands

88 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Other LAI aripiprazole brands Another two long-­acting formulations of aripiprazole lauroxil (Aristada Initio and Aristada) are approved by the US Food and Drug Administration (FDA) for the treatment of schizophrenia.14 Aristada Initio is given as a single 675mg IM injection to initiate treatment (Table 1.14). Aristada is administered at 1-­monthly, 6-­weekly or 2-­monthly intervals by IM injection into the deltoid or gluteal muscle, depending on the dose (Table 1.15).15,16 It is available in four strengths (441mg, 662mg, 882mg and 1064mg doses to deliver 300mg, 450mg, 600mg and 724mg of aripiprazole, respectively).17 The most commonly reported adverse reaction is akathisia.14 The 1-­day initiation regimen with 1064mg Aristada did not demonstrate any new safety or tolerability concerns and its adverse-­effect profile was comparable to that of paliperidone palmitate 1-­monthly injection.13,18 Most adverse reactions occurred within the first 4 weeks of treatment (injection-­site pain, akathisia, increased weight).18 Aristada 1064mg and Ari 2MRTU both give therapeutic plasma levels over the entire 2-­month dosing interval.19 The key differences between the two formulations lie in their dosing and the licensed indications. Aristada 1064mg corresponds to 15mg daily oral aripiprazole, while Ari 2MRTU is claimed to be suitable for patients taking 10–20mg of oral aripiprazole daily. While both formulations are licensed for the treatment of schizophrenia, Ari 2MRTU is also approved for the maintenance treatment of bipolar I disorder in the USA. Table 1.15  Equivalent doses and sites of administration for Aristada.17 Aripiprazole oral (mg/day) Aripiprazole lauroxil dose (mg) Dosing interval Site of IM administration 441 Monthly Deltoid or gluteal 662 Monthly Gluteal ≥20 Monthly Gluteal 882 Every 6 weeks Gluteal 1064 Every 2 months Gluteal Table 1.14  Starting treatment with Aristada.17 1-­day initiation regimen Second option Establish tolerability with oral aripiprazole before initiating treatment Establish tolerability with oral aripiprazole before initiating treatment Give single dose of 675mg IM Aristada Initio* into the gluteal muscle Give IM Aristada on day one** and continue oral aripiprazole for 21 days Give single dose of 30mg aripiprazole Give IM Aristada on the same day or up to 10 days after initiation** * Avoid giving Aristada Initio and Aristada into the same muscle. ** Only the 441mg dose can be given in the deltoid muscle; 662mg, 882mg and 1064mg must be given into the gluteal muscle.