NEW – Abilify Maintena® (aripiprazole) depot injection now available

 In Pharmacy Information, Simplifying Product Supply

Abilify Maintena® (aripiprazole) long lasting injection is now available in the UK and is licensed for the treatment of schizophrenia in adults.

This new form of aripiprazole delivers long-term efficacy, controls the symptoms of schizophrenia and is enhanced by a comprehensive safety and tolerability profile. Aripiprazole was the first dopamine system stabiliser used to treat schizophrenia and it has been suggested that it works in a different way to all other antipsychotics.

Aripiprazole is already available in a variety of forms, including tablet, liquid and rapid tranquillisation injection. Due to the long lasting nature of the depot injection, it is recommended that only patients who are already stabilised with oral aripiprazole should be considered for treatment with Abilify Maintena®. This is to ensure their tolerability is already established, as any side-effects that occur will be much longer lasting than with other forms of the drug.

There are some alternative long-acting antipsychotic injections to Abilify Maintena® including Risperdal Consta® (risperidone), ZypAdhera® (olanzapine), and Xepilon® (paliperidone) as well as the other depot medications.

The advantages of depot injections

Depot or long-lasting injections in their very nature require less frequent administration than other forms of medication, due to their longer lasting efficacy. This eliminates the necessity for tablets or capsules to be taken on a daily basis and helps to reduce any uncertainty about the amount of medication taken or not taken.
Depot injections provide a more consistent delivery of medication, helping to minimise side-effects and reduce variations in symptom control.

Should a patient refuse an injection, there is also a much wider window of opportunity to re-engage assertively with a patient, as plasma levels take longer to decline after the last dose than with oral formulations. All of this helps to reduce relapse rates, leading to better outcomes and a reduced risk of re-admission after a patient has been discharged.

Administration and dosage recommendations

Abilify Maintena® should be injected into the gluteal muscle, from where the active moiety is slowly released into the circulation.

Maximum concentration is achieved in 5 to 7 days. It is recommended that it should be administered monthly in a 400mg dose in order to ensure the drug remains effective, but no sooner than 26 days after the previous injection.

After the first injection, treatment with 10mg to 20mg oral aripiprazole should be continued for 14 consecutive days to maintain therapeutic aripiprazole concentrations during the initiation of therapy. A steady state should be achieved after the fourth injection.

If there are adverse reactions with the 400mg dosage, a reduction to 300mg once monthly should be considered.

Should the second or third dose be missed and the time since the last injection becomes more than 5 weeks, oral aripiprazole should be restarted for 14 days with the next administered injection, then resume the monthly injection cycle. If the time since the last injection is less than 5 weeks, simply administer an injection and resume the monthly injection cycle without the need for oral treatment.

Once a steady state has been achieved after the fourth dose, the same applies, but the time since the last injection can stretch to 6 weeks without the need for oral treatment.

It should be noted that the safety and efficacy of Abilify Maintena® in the treatment of schizophrenia in patients 65 years or older has not been established.

Guidance and training

The summary of product characteristics for Abilify Maintena® is available from:
http://tinyurl.com/pjnthxb

Guidance on the administration of antipsychotic depot and long-acting injections is available here:
http://www.reach4resource.co.uk/sites/default/files/pdf6.pdf

There is a range of free e-learning courses available providing help on the correct administration of depot injection available here:
http://www.reach4resource.co.uk/tools-resources

NICE has produced a summary of the evidence for Abilify Maintena® and it is available from:
http://tinyurl.com/o6src3o
Written by:

Martin England
Pharmacy Services Director & Editor

 

Photo by en:User:Sponge [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons

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