Converting Abilify Maintena 400mg to Oral Aripiprazole
When converting from Abilify Maintena 400mg monthly injection to oral aripiprazole, continue oral aripiprazole 10-20 mg daily for 14 days after the last injection, then discontinue the oral medication as the long-acting formulation maintains therapeutic levels. 1
Conversion Rationale and Pharmacokinetics
The conversion strategy is based on the pharmacokinetic profile of aripiprazole:
- Aripiprazole has an extremely long elimination half-life of approximately 75 hours (about 3 days) for the parent compound and 94 hours for the active metabolite dehydro-aripiprazole 2, 3
- Steady-state plasma concentrations are achieved within 14 days of dosing 2, 3
- After initiating Abilify Maintena 400mg, median aripiprazole plasma concentrations reach therapeutic levels within 7 days, with a 14-day overlap considered sufficient to ensure therapeutic concentrations 1
Specific Conversion Protocol
If transitioning FROM long-acting TO oral therapy:
- The therapeutic window for aripiprazole is 94.0-534.0 ng/mL 1
- Abilify Maintena 400mg produces mean plasma concentrations of 93-112 ng/mL after 4 weeks, which falls within the therapeutic range 1
- Start oral aripiprazole 10-15 mg daily immediately when discontinuing the monthly injection 2, 1
- The oral dose range of 10-30 mg/day has been shown to be effective, with most patients requiring 10-25 mg/day for optimal antipsychotic effect 4
Dosing Considerations
The recommended starting and target dose for oral aripiprazole is 10 or 15 mg/day administered once daily without regard to meals 3:
- Dosage increases should not be made before 2 weeks of continuous therapy, the time needed to achieve steady state 3
- At least 1-2 weeks, and sometimes up to 4 weeks, may pass before aripiprazole reaches its full effect 3
- In clinical studies, 90.1% (1296/1439) of patients initiated on Abilify Maintena 400mg required no dose change, indicating this dose corresponds well to the 10-20 mg oral range 1
Important Clinical Caveats
When switching between formulations, cross-titration timing matters:
- A cross-titration period of >1 to 4 weeks is better tolerated than ≤1 week, with lower discontinuation rates due to adverse events (2.7% vs 10.4%) 1
- The efficacy and safety of Abilify Maintena 400mg were comparable between patients previously stabilized on oral aripiprazole 10 mg or 30 mg daily 1
- Less than 10 mg/day oral aripiprazole does not show significant efficacy on schizophrenia symptoms, except for specific short-term effects on agitation at very low doses 4