Transitioning from Oral to Injectable Aripiprazole (Abilify)
When transitioning from oral to intramuscular (IM) aripiprazole, you should continue oral aripiprazole for 14 days after starting the IM injection to ensure therapeutic levels are maintained during the transition period. 1, 2
Understanding Aripiprazole Pharmacokinetics
- Aripiprazole has a long half-life of approximately 75 hours, which means it takes time to reach steady-state concentrations in the body 3
- Steady-state concentrations are attained within 14 days of dosing for both aripiprazole and its active metabolite dehydroaripiprazole 1
- The full therapeutic effect of aripiprazole may take 1-2 weeks, and sometimes up to 4 weeks, to be fully realized 1
Recommended Transition Protocol
- After administering the IM dose of aripiprazole, continue your current oral aripiprazole dose for 14 days 1, 2
- This 14-day overlap ensures therapeutic drug levels are maintained while the IM formulation reaches steady-state 3
- Stopping oral aripiprazole too soon may result in subtherapeutic levels and potential symptom recurrence 4
Dosing Considerations
- The transition period is critical regardless of which IM formulation you're using (aripiprazole monohydrate or aripiprazole lauroxil) 2
- No dosage adjustments are typically needed during this transition period unless you experience side effects 4
- If you experience significant side effects during the overlap period, consult your healthcare provider as this could indicate excessive total aripiprazole exposure 2
Monitoring During Transition
- Be alert for potential side effects during the transition period, particularly akathisia (restlessness) and tremor, which occur at higher rates with aripiprazole compared to placebo (though still generally uncommon at 10-11% or less) 2
- Unlike many other antipsychotics, aripiprazole has a favorable metabolic profile with lower risk of weight gain 4, 3
- Aripiprazole also has a favorable cardiovascular profile with minimal QTc interval prolongation 3, 2
Common Pitfalls to Avoid
- Stopping oral medication too soon (before 14 days) may lead to inadequate blood levels and potential symptom recurrence 1
- Continuing oral medication beyond 14 days without medical advice could potentially lead to excessive total aripiprazole exposure 2
- Failing to maintain consistent dosing during the transition period may affect the stability of your treatment 4
Remember that this 14-day overlap period is essential to maintain therapeutic drug levels while transitioning from oral to IM aripiprazole formulations 1, 2.