Exploring Abilify Maintena: A Long-Acting Injectable for Schizophrenia and Bipolar I

Exploring Abilify Maintena: A Long-Acting Injectable for Schizophrenia and Bipolar I

For individuals living with schizophrenia or bipolar I disorder, adhering to a daily medication routine can be challenging. However, Abilify Maintena offers a convenient dosing option. This long-acting injectable formulation of aripiprazole can be administered once every 2 months for maintenance treatment.

What is Abilify Maintena?

Abilify Maintena is an extended-release intramuscular injectable containing aripiprazole. It was approved by the U.S. Food and Drug Administration (FDA) in 2013 for schizophrenia and bipolar I disorder treatment in adults.

Unlike the oral tablet that must be taken daily, a health care professional administers the Abilify Maintena injection once every 4 or 6 weeks. This long-acting medicine then slowly releases aripiprazole over time to maintain stable medication levels in the body.

How Abilify Maintena Works

Abilify Maintenas active ingredient, aripiprazole, is an atypical antipsychotic. It works by adjusting levels of dopamine and serotonin in the brain to improve thinking, moods, behaviors, and emotional responses.

The medicine is formulated as lyophilized powder that comes packaged with sterile water. A healthcare provider reconstitutes the powder into a solution for injection. The water allows the powder to dissolve slowly, releasing aripiprazole steadily over one month or two months, depending on the prescribed dose.

Benefits of Long-Acting Injectables

Long-acting injectables like Abilify Maintena offer several advantages over daily oral antipsychotic medications:

• More consistent medication delivery with stable blood plasma levels
• Avoids daily pill-taking which can be difficult for some patients
• Eliminates need to remember daily doses
• Improved medication adherence and lower relapse rates
• Less peak-to-trough fluctuations in drug levels
• Monthly clinic visits encourage provider engagement

For many patients, Abilify Maintena enhances treatment compliance while allowing freedom from tracking daily oral medication. It also provides reassurance to caregivers about consistent dosing.

Approved Uses of Abilify Maintena

The FDA has approved Abilify Maintena for the following uses:

• Schizophrenia: Abilify Maintena is FDA-approved to treat schizophrenia in adults when used as monotherapy or alongside other medicines.
• Bipolar I Disorder: It can treat bipolar manic or mixed episodes in adults and be used for maintenance monotherapy treatment.

Abilify Maintena has not been approved to treat dementia-related psychosis or mood disorder diagnoses beyond bipolar I, such as bipolar II or major depressive disorder.

Effectiveness for Schizophrenia and Bipolar I

Clinical studies have found Abilify Maintena effective for schizophrenia and bipolar I maintenance therapy. Results showed the long-acting injectable could:

• Reduce relapse rates compared to placebo injections
• Safely allow transition from the oral tablet formulation
• Improve symptoms and maintain stability when given alongside other medications

One study specifically looked at Abilify Maintena's efficacy for bipolar I patients. Over a 52-week period, the 2-month injection significantly delayed recurrent manic or mixed episodes compared to placebo.

Dosage and Administration

A healthcare provider administers Abilify Maintena via intramuscular injection in the upper arm or buttocks. There are two dosing options:

• Every 4 weeks: 300 mg or 400 mg injections given monthly
• Every 6 weeks: 300 mg, 400 mg, or 600 mg injections given every two months

When starting Abilify Maintena, patients must first establish tolerability using Abilify oral tablets for a minimum of 14 days. The final oral dose should match the initial injection dose. Loading injections are then given for the first month or two of treatment.

Potential Side Effects

As with most antipsychotic medications, Abilify Maintena may cause certain side effects. The most common include:

• Injection site pain
• Headache
• Akathisia (inner restlessness)
• Dizziness
• Somnolence
• Tremor
• Nausea

Less common side effects can include weight gain, insomnia, anxiety, constipation, and vomiting. Rare but serious reactions involve fainting, neuroleptic malignant syndrome, and pathological gambling.

Patients should promptly report any concerning side effects to their prescriber. Never stop taking Abilify Maintena suddenly without medical supervision, as this can trigger withdrawal symptoms.

Warnings and Precautions

There are several important precautions regarding Abilify Maintena therapy:

• May increase the risk of suicidal thoughts and behaviors in young adults aged 18-24 years old
• Elderly patients with dementia-related psychosis can experience increased risk of death
• Neuroleptic malignant syndrome is a rare but life-threatening reaction that requires emergency care
• High blood sugar, weight gain, and abnormal lipid levels may occur
• Orthostatic hypotension is possible, especially in elderly patients
• Tardive dyskinesia involving involuntary muscle movements can develop with long-term use

Before starting treatment, discuss your full medical history and any other medications with your prescriber. Blood tests, body measurements, and glucose monitoring may be needed periodically during therapy.

Drug Interactions

Some significant drug interactions may occur between Abilify Maintena and other medications. This includes drugs that:

• Prolong the QT interval on an EKG
• Are CYP2D6 or CYP3A4 inhibitors or inducers
• Increase dopamine signaling in the brain
• Have anticholinergic effects
• Lower the seizure threshold

Examples of medications that may interact with Abilify Maintena include antifungals, macrolide antibiotics, prostate medications, antidepressants, anticonvulsants, antiarrhythmics, and antimalarials. Patients should always inform providers about any other drugs, herbals products, or supplements taken.

Special Patient Populations

No dosage adjustments are required based on gender, race, ethnicity, or renal impairment status. However, the elderly and those with hepatic impairment do require caution and possible dose adjustments. Abilify Maintena is not approved for pediatric patients under 18 years old.

The injectable formulation has not been studied in pregnancy. Oral aripiprazole showed some risks during pregnancy. Breastfeeding is not recommended while on treatment. Patients should discuss family planning and contraceptive options with their healthcare provider before starting Abilify Maintena.

How Supplied and Stored

Abilify Maintena extended-release injectable suspension comes as a powder in a sterile single-dose vial. There are 4 dosing options:

• 300 mg of aripiprazole in vials packaged with 2 mL of sterile water
• 400 mg of aripiprazole in vials with 2.3 mL of sterile water
• 600 mg of aripiprazole in vials packaged with 3.8 mL of sterile water
• Starter kit: 400 mg vial with 1.9 mL water and prefilled syringes

The powder and solvent vials must be refrigerated at 36F to 46F (2C to 8C) until ready to reconstitute. Do not freeze. Protect from light by keeping in the original carton. The solution should be used immediately once prepared but can be stored below 77F (25C) for up to 4 hours.

Considerations Before Starting

There are several factors patients should think about before beginning treatment with Abilify Maintena:

• Injection site reactions are common - rotate injection areas as directed
• The 2-month dosing schedule requires appointment planning
• Effects last long after each injection, so side effects may persist
• Sudden discontinuation can cause withdrawal symptoms
• Oral overlap therapy is required for the first 2 weeks
• Takes about 2-3 months to reach steady state concentrations

Discuss your preferences and concerns about injections and office visits with your mental health provider. With proper planning and expectations, many patients adjust well to this long-acting antipsychotic therapy.

The Role of Abilify Maintena for Schizophrenia and Bipolar I

For individuals struggling to stick to a daily oral medication routine, Abilify Maintena offers a convenient alternative. This long-acting injectable antipsychotic is approved to treat schizophrenia and bipolar I disorder.

While not appropriate for all patients, Abilify Maintena benefits those needing more structure and compliance with maintenance therapy. Regular injections replace daily pill-taking - an advantage for many people challenged by adherence.

However, the 2-month dosing schedule requires commitment. There is no flexibility to adjust or stop the medication once the injection is given. Patients must tolerate the sustained effects until the drug clears. But with open communication and the right expectations, Abilify Maintena can be a useful treatment option.

Key Points

• Abilify Maintena is an intramuscular injection given once every 4 or 6 weeks.
• It provides steady delivery of the antipsychotic medication aripiprazole.
• Abilify Maintena is FDA-approved to treat schizophrenia and bipolar I disorder.
• It can improve compliance over daily oral medication regimens.
• Careful consideration of the dosing schedule and potential side effects is needed.
• Ongoing provider engagement is important for long-term success.

For the right person, Abilify Maintena may provide welcome stabilization and freedom from tracking daily antipsychotic therapy. This long-acting injectable offers a therapeutic option for managing schizophrenia, bipolar mania, and maintenance - when taken properly under medical supervision.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.