Transitioning from Monthly to Bi-Weekly Abilify (Aripiprazole) Injection
There is no established protocol for transitioning from monthly aripiprazole long-acting injectable (LAI) to a bi-weekly formulation because bi-weekly aripiprazole LAI does not exist as an approved product. 1, 2
Available Aripiprazole LAI Formulations
The currently FDA-approved aripiprazole long-acting injectable formulations are:
- Aripiprazole once-monthly 400 mg (AOM 400) - administered every 28 days via gluteal or deltoid injection 3, 2
- Aripiprazole lauroxil (AL) 1064 mg - administered every 2 months (56 days) via gluteal injection 1
- Aripiprazole 2-month ready-to-use 960 mg (Ari 2MRTU 960) - administered every 2 months (56 days) via gluteal injection 1, 2
If You Mean Transitioning to Every-Two-Months Dosing
If your question is about transitioning from monthly (every 28 days) to every-two-months (every 56 days) aripiprazole LAI, this can be accomplished by switching from AOM 400 to either AL 1064 mg or Ari 2MRTU 960. 1, 2
Recommended Transition Protocol
Continue the monthly AOM 400 regimen while initiating the first dose of the every-two-months formulation (AL 1064 mg or Ari 2MRTU 960), then discontinue monthly injections after the first bi-monthly dose is administered 1, 2
For AL 1064 mg specifically, a 1-day oral aripiprazole initiation regimen may be required depending on the patient's current oral supplementation status 1
For Ari 2MRTU 960, no additional oral overlap is necessary if the patient is already stabilized on AOM 400, as the pharmacokinetic profiles are equivalent (GMR 1.006,90% CI 0.851-1.190) 2
Critical Monitoring During Transition
Assess symptom stability at 4-6 weeks after the first bi-monthly injection using standardized rating scales (PANSS for schizophrenia, YMRS for bipolar mania) to ensure adequate therapeutic coverage 4, 5
Monitor for injection-site reactions, which occur in 18.2% of patients receiving Ari 2MRTU 960 compared to 9.0% with monthly formulations 2
Watch for extrapyramidal symptoms and weight changes, as these are the most common treatment-emergent adverse events (weight gain: 22.7% with Ari 2MRTU 960; 20.9% with AOM 400) 2
Common Pitfalls to Avoid
Do not attempt to give monthly formulations every two weeks - this would result in supratherapeutic dosing and increased adverse effects, as the pharmacokinetics are designed for 28-day intervals 3, 2
Do not discontinue monthly injections prematurely before the bi-monthly formulation reaches steady-state coverage, as this creates a gap in D2 receptor occupancy and increases relapse risk 4, 5
Confirm the patient has been adherent and stable on monthly injections for at least 4 months before considering transition to less frequent dosing, as longer intervals require greater treatment stability 1, 2