Aripiprazole monohydrate LAI
ABILIFY MAINTENA
“Man-tenna”
What it isLong-acting dopamine partial agonist with serotonin-receptor activity; schizophrenia and maintenance of bipolar I disorder.
Why this oneUnlike aripiprazole lauroxil, it also carries a bipolar I maintenance indication.
What limits itInitiation needs two weeks of overlapping oral aripiprazole (or the two-injection start), and akathisia remains the characteristic complaint.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adults | See initiation (1-day or 14-day) | 400 mg IM monthly | — |
| Bipolar I disorder (maintenance monotherapy) | Adults | See initiation (1-day or 14-day) | 400 mg IM monthly | — |
Renal Undefined
Hepatic Undefined
400 mg monthly, no sooner than 26 days after the previous injection
Instructions
- IM (deltoid or gluteal) by a healthcare professional
- Establish tolerability with oral aripiprazole first
- 1-day initiation: two 400 mg injections + oral aripiprazole 20 mg; or 14-day: 400 mg + 14 days oral aripiprazole 10–20 mg
- May reduce to 300 mg monthly for adverse reactions
- CYP2D6 poor metabolizers: 300 mg monthly
Available strengths
- inj 300, 400 mg (monthly)
Cautions
- Increased mortality in elderly with dementia-related psychosis (boxed) and cerebrovascular reactions/stroke
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
- Pathological gambling and other compulsive behaviors
- Orthostatic hypotension/syncope
- Leukopenia, neutropenia, agranulocytosis
- Seizures
- Cognitive/motor impairment
Adverse reactions
- Increased weight
- Akathisia
- Injection site pain
- Sedation
Pregnancy Third-trimester exposure: risk of neonatal extrapyramidal/withdrawal symptoms; may decrease milk supply. Registry available.
Lactation Present in human breast milk; may cause clinically relevant decreases in milk supply; monitor infant for dehydration and poor weight gain.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 300 mg | inj | per unit | not offered | |
| 400 mg | inj | per unit | not offered |
Other forms: Aripiprazole (ABILIFY) · Aripiprazole monohydrate LAI (ABILIFY ASIMTUFII)
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Active metabolites
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