What should I consider and how do I change or switch a patient from a different long acting injectable (LAI) antipsychotic medication to Aristada?

When changing or switching from a different LAI to aripiprazole lauroxil (Aristada), stop the 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) need for longer duration of coverage (Maintena is only available as a monthly injection whereas Aristada can be given every 6 or every 8 weeks). 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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