Can a person receive two Abilify (aripiprazole) long-acting injections to overlap the oral period?

Aripiprazole Long-Acting Injection Administration Protocol

Two Abilify long-acting injections can be administered to overlap the oral period using the two-injection start (TIS) regimen, which is pharmacokinetically advantageous and potentially safer than the traditional one-injection start (OIS) regimen. 1

Two-Injection Start (TIS) Protocol

The TIS regimen involves:

• Two 400 mg injections administered simultaneously (one in each gluteal muscle)
• A single 20 mg oral aripiprazole dose on the same day
• No need for the traditional 14-day oral supplementation

Benefits of TIS Approach

• Provides therapeutic blood levels within the appropriate window immediately 1
• Avoids potential toxicity from peaks above the therapeutic window seen with the traditional approach 1
• Simplifies the transition process for patients
• Eliminates the need for extended oral medication overlap
• Demonstrates comparable efficacy to the traditional approach 1

Traditional One-Injection Start (OIS) Comparison

The standard initiation protocol for aripiprazole long-acting injectable requires:

• One 400 mg injection
• 14 days of oral aripiprazole supplementation (10-20 mg daily) 2
• Potential for blood level peaks above therapeutic window 1

Clinical Considerations

Patient Selection

TIS may be particularly beneficial for:

• Patients with adherence concerns
• Patients who may struggle with remembering to take daily oral medication
• Patients transitioning from other antipsychotics

Monitoring Requirements

• Assess for injection site reactions after administration
• Monitor for extrapyramidal symptoms, particularly akathisia
• Review concomitant medications for potential drug interactions with CYP2D6 inhibitors/inducers 2

Pharmacokinetic Advantages

• The TIS approach maintains serum blood levels within the therapeutic window
• OIS approach can lead to peaks above the therapeutic window, potentially exposing patients to toxicity 1
• Both approaches demonstrate similar improvements in psychopathology measures 1

Special Considerations

• Both regimens are effective regardless of substance use disorder comorbidity 1
• Treatment is generally well-tolerated with either approach 1
• Simple constitution with sterile water and no refrigeration requirement make storage and administration easier 2

Implementation Recommendations

1. Confirm patient is stabilized on oral aripiprazole before initiating long-acting injectable
2. Administer two 400 mg injections (one in each gluteal muscle) on the same day
3. Provide a single 20 mg oral aripiprazole dose on the same day
4. Schedule follow-up appointment for the next maintenance dose (monthly)

The TIS approach represents an evidence-based alternative to the traditional OIS regimen that maintains therapeutic efficacy while potentially improving safety and simplifying the transition process.