Switching Noncompliant Abilify Patients to Aristada LAI
Yes, you can and should switch a patient noncompliant with oral Abilify (aripiprazole) to Aristada (aripiprazole lauroxil) LAI, as long-acting injectables are specifically designed to address adherence issues and improve outcomes in patients with poor medication compliance. 1, 2
Primary Indication for LAI Formulations
- LAI antipsychotics are particularly recommended for patients with recurrent relapses related to nonadherence to oral preparations, making this an ideal scenario for switching from oral Abilify to Aristada. 3
- Adherence has been shown to be better with long-acting injectables compared with oral medications, directly addressing your patient's noncompliance issue. 4
- The American Psychiatric Association recommends considering long-acting injectable antipsychotics for patients with a history of poor adherence. 1
Critical Requirement: Oral Coverage Period
You must provide oral aripiprazole coverage for the first 21 days after the first Aristada injection, which is a key disadvantage compared to some other LAI formulations. 5
- This oral coverage requirement creates a practical challenge since your patient is already noncompliant with oral medication. 5
- Consider strategies to ensure adherence during this 21-day period, such as directly observed therapy, pill counts, or family involvement. 1
Dosing Flexibility Advantages
Aristada offers multiple dosing interval options that may improve long-term adherence:
- Available as once-monthly (q4w), every 6 weeks (q6w), or every 2 months (q8w) administration, providing flexibility to tailor therapy to individual patient needs. 3, 2
- Approved doses include 441 mg and 882 mg q4w, 662 mg q4w, 882 mg q6w, and 1064 mg q8w. 3
- The extended dosing intervals (q6w and q8w) represent a unique advantage over aripiprazole monohydrate LAI, which only offers monthly dosing. 3, 2
Expected Tolerability Profile
- Aristada maintains the favorable metabolic profile of oral aripiprazole, with low propensity for metabolic disturbances and weight gain. 3, 6, 7
- The adverse event profile is consistent with oral aripiprazole, except for injection-site reactions. 3, 6
- Monitor closely for extrapyramidal symptoms, especially akathisia, which is well documented with aripiprazole preparations. 5, 7
Common Pitfalls to Avoid
- Do not skip the 21-day oral coverage period – this is required for adequate plasma levels while the LAI formulation reaches therapeutic concentrations. 5
- Review concomitant medications for metabolic inducers and inhibitors that may affect aripiprazole levels. 7
- Ensure proper storage and administration technique – Aristada comes as a pre-filled syringe and does not require refrigeration, making it easier to handle than some other LAI formulations. 7
- Avoid assuming the patient will automatically become adherent with LAI – maintain consistent therapeutic relationships to monitor for continued issues. 1
Monitoring Strategy
- Assess for injection-site reactions at each administration. 3, 6
- Monitor for akathisia and other extrapyramidal symptoms, particularly in the first few weeks. 5, 7
- Evaluate treatment response at 4 weeks minimum, as initial antipsychotics should be given at therapeutic dose for at least 4 weeks to properly assess efficacy. 1
- Continue regular assessment of target symptoms, treatment response, and side effects throughout maintenance therapy. 1