Abilify Long-Acting Injection (LAI): Clinical Review of Monthly and Two-Month Formulations
Abilify Maintena 400 mg: Indications, Pharmacokinetics and Administration Technique
Abilify Maintena 400 mg is a long-acting injectable (LAI) formulation of aripiprazole, approved for the maintenance treatment of schizophrenia in adults and as a maintenance option for bipolar I disorderKane 2019. The monthly injection delivers a sustained release of aripiprazole, providing stable plasma concentrations and reducing the risk of relapse associated with missed oral doses. Abilify Maintena is administered as a deep intramuscular injection, typically into the gluteal or deltoid muscle, by a healthcare professional.
Pharmacokinetic studies demonstrate that steady-state levels are achieved after four monthly injections, with a mean elimination half-life of 29.9 days following the 400 mg doseWeiden 2024. The recommended regimen is 400 mg every four weeks, with a 14-day oral aripiprazole overlap required after the first injection to ensure therapeutic coverage. Dose adjustments to 300 mg monthly are permitted for patients experiencing adverse effects or those with hepatic impairment. For a detailed oral-to-LAI conversion schedule, see our oral-to-LAI conversion schedule.
Aristada (Aripiprazole Lauroxil) vs Abilify Maintena: Dose, Interval and Needle Kits
Aristada (aripiprazole lauroxil) is another abilify long acting injectable, offering a range of dosing intervals and strengths. Unlike Abilify Maintena, Aristada is available in 441 mg, 662 mg, 882 mg, and 1064 mg doses, with administration intervals ranging from every four weeks (441–882 mg) to every six weeks (882 mg) and every eight weeks (1064 mg)Weiden 2024. Aristada is administered intramuscularly in the gluteal or deltoid muscle, with needle kits tailored to the specific dose and injection site.
The pharmacokinetics of Aristada differ from Maintena due to its prodrug formulation, resulting in a delayed conversion to active aripiprazole and a longer time to reach steady-state. A 21-day oral aripiprazole overlap is required after the first Aristada injection. The choice between Abilify Maintena and Aristada depends on patient preference, dosing flexibility, and tolerability. For a comprehensive comparison of other LAI antipsychotics, see our other LAI antipsychotics vs Abilify resource.
| Formulation | Dose (mg) | Interval | Oral Overlap |
|---|---|---|---|
| Abilify Maintena | 400 | Every 4 weeks | 14 days |
| Aristada | 441, 662, 882 | Every 4 weeks | 21 days |
| Aristada | 882 | Every 6 weeks | 21 days |
| Aristada | 1064 | Every 8 weeks | 21 days |
Abilify Asimtufii 960 mg: Two-Month Injection Dosing and Loading Protocol
Abilify Asimtufii is the newest addition to the aripiprazole LAI family, offering a 960 mg dose administered every two months. This formulation is designed for adults with schizophrenia or bipolar I disorder who are stabilized on oral aripiprazole or another LAIWeiden 2024. The two-month interval provides greater convenience and may improve adherence for patients who struggle with monthly appointments.
The loading protocol for Abilify Asimtufii requires that patients be stabilized on oral aripiprazole (10–30 mg daily) or a monthly LAI for at least two months prior to the first injection. No oral overlap is needed if switching directly from a monthly LAI. The injection is administered intramuscularly in the gluteal muscle. Dose adjustments are not recommended; patients requiring lower doses should use alternative formulations. For more on oral-to-LAI conversion, see our oral-to-LAI conversion schedule.
Abilify Injection Cost and Savings: Maintena, Aristada and Asimtufii Compared
The abilify injection cost is a significant consideration for patients and healthcare systems. As of 2024, the average wholesale price for Abilify Maintena 400 mg is approximately $1,650 per monthly injection, while Aristada 882 mg costs around $1,725 per dose. Abilify Asimtufii 960 mg, given every two months, is priced at roughly $3,200 per injection, translating to $1,600 per monthKane 2019. These prices do not include administration fees or potential discounts from insurance or manufacturer programs.
Savings strategies include manufacturer copay cards, patient assistance programs, and insurance prior authorization. Medicaid and Medicare often cover LAI antipsychotics, but out-of-pocket costs can vary. Compared to oral aripiprazole, which averages $60–$90 per month for generic tablets, LAI formulations are substantially more expensive but may reduce hospitalization and relapse rates, offsetting long-term costs. For a detailed price comparison, see our price difference between oral and injectable forms.
| Formulation | Dose | Interval | Cost per Injection | Monthly Equivalent |
|---|---|---|---|---|
| Abilify Maintena | 400 mg | 4 weeks | $1,650 | $1,650 |
| Aristada | 882 mg | 4–6 weeks | $1,725 | $1,150–$1,725 |
| Abilify Asimtufii | 960 mg | 8 weeks | $3,200 | $1,600 |
| Oral Aripiprazole | 10–30 mg/day | Daily | $60–$90 | $60–$90 |
Switching from Oral Abilify to Long-Acting Injection: Overlap and Taper Guidance
Transitioning from oral aripiprazole to an abilify long acting injectable requires careful planning to maintain therapeutic plasma levels and minimize withdrawal or relapse risk. For Abilify Maintena, a 14-day oral overlap is standard after the first injection. For Aristada, a 21-day oral overlap is required. When switching to Abilify Asimtufii, patients should be stabilized on oral or monthly LAI aripiprazole for at least two months; no additional oral overlap is needed if switching from a monthly LAIKane 2019.
Tapering oral aripiprazole should be individualized based on prior dose, duration of therapy, and patient tolerability. Close monitoring for withdrawal symptoms or emergent side effects is essential during the transition. For detailed tapering protocols and withdrawal management, see our managing withdrawal when switching formulations guide. CYP-mediated drug interactions may necessitate dose adjustments; consult our CYP-mediated interactions affecting LAI resource.
Side Effects of Abilify Long-Acting Injectable vs Oral Tablets
The side effect profile of abilify long acting injectable formulations is broadly similar to that of oral aripiprazole, with some notable differences. Injection-site reactions, including pain, swelling, and induration, are reported in up to 10% of patients but are usually mild and transientWeiden 2024. Systemic side effects such as akathisia, insomnia, and weight gain occur at comparable rates to oral therapy, though some studies suggest a lower incidence of gastrointestinal symptoms with LAI formulations.
Rare but serious adverse events include neuroleptic malignant syndrome, tardive dyskinesia, and impulse-control disorders. The risk of relapse due to missed doses is lower with LAIs, but missed injections can lead to delayed symptom recurrence. For a comprehensive comparison of injection and tablet adverse events, see our comparing injection and tablet adverse events review.
FAQ on Abilify Long-Acting Injection
- How painful is the Abilify shot?
- Most patients report mild to moderate discomfort at the injection site, typically lasting a few minutes to several hours. Pain can be minimized by proper injection technique and allowing the medication to reach room temperature before administration.
- What happens if an Abilify LAI dose is missed?
- If a scheduled injection is missed, the timing and dose of the next injection depend on the length of the delay and the specific formulation. Short delays (less than two weeks) may be managed with immediate administration; longer delays may require oral supplementation or dose adjustment. Clinicians should consult product labeling for specific guidance.
- Can Abilify Maintena be used in pregnancy?
- There are limited data on the use of Abilify Maintena in pregnancy. The decision to continue or initiate LAI therapy should be individualized, weighing maternal benefits against potential fetal risks. Shared decision-making and consultation with a perinatal psychiatrist are recommended.