1.1. Adults
Long-acting injectable (LAI) second generation (atypical) antipsychotics are FDA-approved drugs to treat psychiatric disorders. All of the LAI atypical antipsychotics are used to treat schizophrenia1-14 . Invega Sustenna has an additional indication
for treating schizoaffective disorder 1-3. Both Abilify Maintena, Abilify Asimtufii, Risperdal Consta, and Rykindo have an additional indication for treating bipolar I disorder1,2,4-7. Invega Hafyera is approved for the management of schizophrenia in adult patients, and it is administered every six months1,2,12. Perseris is a monthly injection of risperidone approved for the management of schizophrenia in adults1,2,14. Aristada Initio was approved for the initiation of Aristada, and is only given once in combination with single 30 mg oral dose of aripiprazole1,2,9,10. Recommended treatment dosages for LAI atypical antipsychotics are summarized in Table 1.
| Drug Name | Available Dosage Strengths | Treatment Indication | Maximum Recommended Dosage |
|---|---|---|---|
| Aripiprazole (Abilify Asimtufii) | 720 mg, 960 mg intramuscular (IM) injection | Schizophrenia, bipolar I disorder (maintenance therapy) | 960 mg IM once every two months |
| Aripiprazole (Abilify Maintena) | 300 mg, 400 mg intramuscular (IM) injection | Schizophrenia, bipolar I disorder (maintenance therapy) | 400 mg IM once monthly |
| Aripiprazole lauroxil (Aristada, Aristada Initio) | 441 mg, 662 mg, 675 mg, 882 mg, 1064 mg IM injection | Schizophrenia | 1064 mg IM every two months |
| Olanzapine (Zyprexa Relprevv) | 210 mg, 300 mg, 405 mg IM injection | Schizophrenia | 300 mg IM every two weeks or 405 mg every 4 weeks |
| Paliperidone palmitate (Invega Hafyera) | 1,092 mg, 1,560 mg IM injection | Schizophrenia in patients who have been treated on Invega Sustenna for at least four months or Invega Trinza for at least one three month cycle | 1,560 mg IM every 6 months |
| Paliperidone palmitate (Invega Sustenna) | 39 mg, 78 mg, 117 mg, 156 mg, 234 mg IM injection | Schizophrenia, schizoaffective disorder | 234 mg IM once monthly |
| Paliperidone palmitate (Invega Trinza) | 273 mg, 410 mg, 546 mg, 819 mg IM injection | Schizophrenia in patients who have been treated on Invega Sustenna® for at least four months | 819 mg IM once every 3 months |
| Risperidone (Perseris) | 90 mg, 120 mg IM injection | Schizophrenia | 120 mg IM every month |
| Risperidone (Risperdal Consta) | 12.5 mg, 25 mg, 37.5 mg, 50 mg IM injection | Schizophrenia, bipolar I disorder (maintenance therapy) | 50 mg IM every 2 weeks |
| Risperidone (Rykindo) | 25 mg, 37.5 mg, 50 mg IM injection | Schizophrenia, bipolar I disorder (maintenance therapy) | 50 mg IM every 2 weeks |
| Risperidone (Uzedy) | 50 mg, 75 mg, 100 mg, 125 mg, 150 mg, 200 mg, 250 mg subcutaneous (SubQ) injection | Schizophrenia | 125 mg SubQ once monthly or 250 mg SubQ every 2 months |
Abilify Maintena and Abilify Asimtufii dosages must be modified in patients prescribed CYP3A4 or CYP2D6 inhibitors, or in those patients identified as CYP poor metabolizers. Abilify Maintena and Abilify Asimtufii should be avoided in patients prescribed CYP3A4 inducers concurrently1,2,4,5. Abilify Asumtufii should be avoided in patients taking CYP2D6 and CYP3A4 inhibitors concurrently. Recommended Abilify Maintena and Abilify Asumtufii dosages when prescribed concurrently with CP450-modifying medications are summarized in Table 2.
| Factors | Dosage Adjustment |
|---|---|
| Abilify Maintena® 300 mg intramuscular administration | |
| Strong CYP3A4 or CYP2D6 inhibitor (greater than 14 days) | Reduce to 200 mg |
| CYP3A4 and CYP2D6 inhibitor together (greater than 14 days) | Reduce to 160 mg |
| CYP3A inducer (greater than 14 days) | Avoid use |
| Abilify Maintena® 400 mg intramuscular administration | |
| Strong CYP3A4 or CYP2D6 inhibitor (greater than 14 days) | Reduce to 300 mg |
| CYP3A4 and CYP2D6 inhibitor together (greater than 14 days) | Reduce to 200 mg |
| CYP3A inducer (greater than 14 days) | Avoid use |
| Abilify Maintena® in CYP2D6 poor metabolizers | |
| Known CYP2D6 poor metabolizers | Reduce to 300 mg |
| Known CYP2D6 poor metabolizer taking a CYP3A4 inhibitor | Reduce to 200 mg |
| Abilify Asumtufii® 960 mg intramuscular administration | |
| Concomitant use with strong CYP2D6 inhibitors | 720 mg once every 2 months |
| Concomitant use with strong CYP3A4 inhibitors | 720 mg once every 2 months |
| Concomitant use with strong CYP2D6 inhibitors and strong CYP3A4 inhibitors | Avoid use |
| Concomitant use with CYP3A4 inducers | Avoid use |
| Abilify Asumtufii in CYP2D6 poor metabolizers | |
| Known CYP2D6 poor metabolizers | 720 mg once every 2 months |
| nown CYP2D6 poor metabolizers taking concomitant CYP3A4 inhibitors | Avoid use |
Aristada dosages must be modified in patients prescribed CYP3A4 or CYP2D6 inhibitors as well as CYP3A4 inducers concurrently. Aristada Initio only comes in one dosage strength, and it should be avoided in patients who are known CYP2D6 poor metabolizers or taking strong CYP3A4 inhibitors, strong CYP2D6 inhibitors, or strong CYP3A4 inducers.1,2,9,10 Recommended Aristada dosages when prescribed concurrently with CP450-modifying medications are summarized in Table 3.
| Factors | Dosage Adjustment |
|---|---|
| Strong CYP3A inhibitor | Reduce Aristada dose to the next lowest strength; if patient is taking 441 mg, no dosage adjustment required |
| Strong CYP2D6 inhibitor | Reduce Aristada dose to next lowest strength; if patient is taking 441 mg, no dosage adjustment required |
| Known CYP2D6 poor metabolizer taking a strong CYP3A inhibitor | If patient is taking 662 or 882 mg, reduce the dose to 441 mg; if patient is taking 441 mg, no dosage adjustment required |
| Known CYP2D6 poor metabolizer taking a strong CYP2D6 inhibitor | No dose adjustment needed |
| Both a strong CYP2D6 inhibitor and CYP3A inhibitor | Avoid using in patients who are taking 662 or 882 mg; if patient is taking 441 mg, no dosage adjustment needed |
| CYP3A4 inducers | No dose adjustment is needed for the 662 mg or 882 mg dosages; if patient is taking 441 mg, increase dose to 662 mg |
Aristada Initio should be avoided in patients who are known CYP2D6 poor metabolizers or taking strong CYP3A4 inhibitors, strong CYP2D6 inhibitors, or strong CYP3A4 inducers.