What is the recommended procedure for restarting Abilify (aripiprazole) maintenance therapy after missing doses?

Restarting Abilify Maintenance After Missed Doses

If you have missed doses of Abilify (aripiprazole) maintenance therapy, you should take the missed dose as soon as you remember if it is almost time for your next dose, and then continue with your regular dosing schedule. This approach ensures continued therapeutic effect while minimizing risks of symptom recurrence.

General Guidance for Missed Doses

• For oral aripiprazole, if you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, just take your next dose at the regular time. Do not take two doses of aripiprazole at the same time 1.

• For Abilify Maintena (aripiprazole long-acting injectable), reinitiation is only necessary if 14 weeks or more have passed since your prior injection 2.

Specific Restart Protocols Based on Duration of Missed Treatment

Short-Term Missed Doses (Less than 2 weeks)

• Resume at your previous maintenance dose without dose adjustment 1.
• Monitor for return of symptoms but formal dose titration is typically not required 2.

Extended Missed Doses (More than 2 weeks)

• For oral aripiprazole: Resume at your regular dose but monitor more closely for side effects 1.
• For Abilify Maintena (long-acting injectable): If more than 14 weeks have passed since your last injection, restart the initiation protocol 2.

Monitoring After Restarting

• Watch for symptoms of your condition returning within the first 1-2 weeks after restarting 3.
• Monitor for potential side effects such as:
  • Akathisia or restlessness (occurs in up to 11% of patients) 3
  • Extrapyramidal symptoms (may occur in up to 28% of recipients) 4
  • Metabolic changes (though these are generally minimal with aripiprazole) 3

Important Considerations

• Aripiprazole has a unique mechanism as a partial agonist of dopamine D2 and D3 receptors, which contributes to its efficacy and side effect profile 5.
• Consistent medication adherence is crucial for preventing relapse, as studies show aripiprazole maintenance therapy significantly delays and reduces relapse rates 6.
• Never double-dose to make up for missed doses 1.

Common Pitfalls to Avoid

• Failing to monitor for symptom recurrence after restarting therapy 3.
• Unnecessarily restarting the entire treatment course when simply continuing therapy would be sufficient 2.
• Not accounting for the total number of doses needed to complete therapy 2.

Special Situations

• If you experience significant symptom return after restarting, contact your healthcare provider promptly 1.
• For patients with severe symptoms, more careful monitoring may be needed after restarting therapy 3.