Changing or switching a patient from a different long-acting injectable (LAI) antipsychotic medication to Aristada

Some information presented within this Center of Excellence was created in collaboration with the California Department of State Hospitals (DSH). This includes that the content has been specifically aligned to the DSH’s medication guidelines (DSH Psychotropic Medication Operational Procedures, appended to DSH Policy Directive 3400). These medication guidelines are applicable only to the DSH settings and inclusion within this resource does not indicate that they must be followed in any non-DSH settings. The medication guidelines included in this resource are those of DSH and do not necessarily represent the views, policy(ies), and/or position(s) of the American Psychiatric Association (APA).

current LAI and follow the guidance for using Aristada, including this guidance with regard to establishing tolerability. Practically, it is logical to administer the first dose of Aristada when the previously used LAI is stopped.  Examples include: providing Aristada two weeks following the last Haldol decanoate or Risperdal Consta injection, three weeks following the last Prolixin decanoate injection, or four weeks following the last Invega Sustenna or Abilify Maintena injection.  In a study [1] examining the switch from Invega Sustenna to Aristada, the use of 21 days of oral aripiprazole supplementation after the first Aristada injection was at the clinician’s discretion.  To avoid under-dosing during the transition to Aristada, oral supplementation with 10 – 20 mg of  aripiprazole  or an injection of Aristada Initio 675 mg, plus a one time dose of 30 mg oral,  should be considered to provide coverage during the transition.  To choose between supplementation or not, the clinician would need to weigh the risks of possible side effects, such as akathisia, versus risk of breakthrough psychiatric symptoms.

Although it might seem unusual to consider switching between Abilify Maintena and Aristada, this situation may occur due to 1) insurance coverage; or 2) clinical needs.  One needs to consider dose equivalents and duration of coverage separately. The following table shows aripiprazole LAI doses corresponding to the oral aripiprazole dose ranges.  (Therapeutic drug monitoring along with clinical assessments will lead you to the best dose for your patient!)

Patients treated with Abilify Maintena 400 mg monthly at steady state can be converted safely to and stabilized on Aristada 882 mg at 4 weeks following the last Abilify Maintena administration.

FDA Medication Label

• Information on this topic is found in the FDA medication label. Here is the most recent label, at time of writing.
• Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices. Labels change over time, and the current label should always be consulted.

References

1. Miller B, Claxton A, Du Y, Weiden P, Potkin S. Switching patients with schizophrenia from paliperidone palmitate to aripiprazole lauroxil: a 6-month, prospective, open-label study. Schizophr Res. 2019; 208:44-48
2. Alkermes, Inc. Data on file (Final Clinical Study Protocol ALK9072-A401). Waltham, MA; September 2016.

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