Do AP injections make the medicine work better than taking orally?

[CeremonyNewOrder]

My pdoc wants me to take my abilify via an injection shot now. She says it will make the medicine work better. I always thought injections were for people who refused to take their meds. Anyone have experience with this? Thanks.

[browri]

On 10/12/2020 at 8:01 PM, CeremonyNewOrder said:

My pdoc wants me to take my abilify via an injection shot now. She says it will make the medicine work better. I always thought injections were for people who refused to take their meds. Anyone have experience with this? Thanks.

You are right that, historically, the motivation of the pharmaceutical industry to develop LAI (long-acting injectable) antipsychotics was due to adherence/compliance issues. However, serendipitously discovered as well was the welcome/blissful ignorance to the antipsychotic. For many, I'm sure that even if you didn't take a pill every day, you may still feel that you are medicated, but not having to take a pill every day helps you to think less about the fact that you're taking an antipsychotic medication. And perhaps that may improve your mood overall by helping to keep your mind off of it. Does that make sense?

[browri]

I will also say that if it truly is the motivation of your doctor to help you think about your medication less, then they should be trying to move you towards Aristada which is a prodrug called aripiprazole lauroxil. At the 1064mg dose, it allows for 2 months between injections.

Some of the data would indicate that perhaps better symptom control can be achieved with LAIs of compounds that already have long half-lives. For example, the 1064mg dose every two months is typically for those that are stable on an oral dose of aripiprazole that is 15mg daily. For daily oral doses of 20mg or higher (such as your own), the recommended conversion is 882mg/monthly, which wouldn't reduce administration frequency relative to Abilify Maintena but could still improve symptom control and overall treatment satisfaction.

If you're happy with Abilify as a treatment option, you're open to your pdoc's idea, and your insurance will cover the specific brand, ask your pdoc about Aristada. It has better pharmacokinetics than Abilify Maintena (fewer peaks and valleys in blood concentrations).

[CeremonyNewOrder]

Browri, thanks for the information. I got my Abilify Maintena shot last week and am feeling a little better mood wise but still hearing voices. My pdoc says she started me on a lower dose in case there were any hiccups. I'll ask about Aristada.

[browri]

17 hours ago, CeremonyNewOrder said:

Browri, thanks for the information. I got my Abilify Maintena shot last week and am feeling a little better mood wise but still hearing voices. My pdoc says she started me on a lower dose in case there were any hiccups. I'll ask about Aristada.

So the way Abilify Maintena works, according to their site:

- Comes in 300mg and 400mg pre-filled syringes or vial kits for custom dose adjustments

- Usually given 400mg in tandem with 10-20mg of oral Abilify for 2 weeks.

-If a lower dose is needed, then use the 300mg syringe or a custom dose with the vial kits.

If your pdoc said she gave you a lower dose to make sure there weren't any hiccups, she probably gave you the 300mg dose. However, if you've been taking 30mg oral Abilify up to this point, I imagine you'll end up needing that 400mg dose. So if your first month on the 300mg dose doesn't go so well, then your pdoc will likely do the 400mg dose next month. If you still need more than that, then the third month you would move to Aristada, which comes in 4 different strengths combined with 3 different dosing periods for 5 different "doses":

- 10mg day = 441mg / 4 weeks

- 15mg day = 662mg / 4 weeks -OR- 882mg / 6 weeks -OR- 1064mg / 8 weeks

- 20mg+ day = 882mg / 4 weeks

The next logical step from 400mg/4wk Abilify Maintena would be 662mg/4wk Aristada, then 882mg/4-6wk.