In my opinion, given the huge problem of nonadherence with antipsychotic treatment, extended-release preparations of antipsychotics should probably be used a lot more often than they are.
In the US, aripiprazole is available in two different extended-release injectable (“depot”) forms: aripiprazole lauroxil (brand name: Aristada®) and aripiprazole extended-release injectable (brand name: Abilify Maintena®).
What are the potential advantages of each of them? Both Aristada® and Abilify Maintena® contain the same medication–aripiprazole. The choice between the two products is based on differences in the convenience of administration and use. Different factors may be more important in one patient versus in another.
Potential advantages of aripiprazole lauroxil (Aristada®)
1. Pre-filled syringe
Aristada® comes in a pre-filled syringe that does not require reconstitution. It only requires some tapping and shaking to make sure the contents are well mixed prior to injection. On the other hand, Abilify Maintena® comes either as a single use vial in dual chamber syringe. One chamber contains powder and the other contains the diluent. Prior to administration, the diluent has to be released into the other chamber by twisting the plunger. Thus, Aristada® is a bit easier to administer.
2. 3. Available in three strengths
Aristada® comes in three different strengths while Abilify Maintena® comes in only two strengths. So, a bit more dose flexibility with Aristada®.
3. May have longer interval between doses
At its highest dose (882 mg), there is an option to give Aristada® every 6 weeks while Abilify Maintena® has to be given every 4 weeks.
Potential advantages of aripiprazole extended-release injectable (Abilify Maintena®)
1. Only 14 days of oral antipsychotic is recommended when treatment with Abilify Maintena® is started.
In contrast, for Aristada®, 21 days of treatment with oral aripiprazole is recommended when treatment with Aristada® is started.
2. Deltoid injection is possible
Giving an injection in the deltoid is so much more convenient than giving it in the gluteal region. All doses of Abilify Maintena can be given in either the deltoid or the gluteal region. With Aristada®, only the lowest dose (i.e., 441 mg) can be given in the deltoid or in the gluteal region. Other doses must be given in the gluteal region.
3. Thinner needles
Abilify Maintena® needles are thinner and, therefore, may be less painful to administer.
Note: higher gauge number in needles means a thinner needle. A 20 gauge needle is thicker than a 23 gauge needle.
Abilify Maintena® comes with the following three needles:
– One 23 gauge, 1 inch (25 mm) needle for deltoid administration in non-obese patients
– One 22 gauge, 1.5 inch (38 mm) needle for gluteal administration in non-obese patients or deltoid administration in obese patients
– One 21 gauge, 2 inch (51 mm) needle with for gluteal administration in obese patients
Aristada® comes with:
– a 2 inch, 20 gauge needle
– a 1.5 inch, 20 gauge needle
– a 1 inch, 21 gauge needle (only for the 441 mg dose administered into the deltoid)
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