07. LAIs in Practice: Aripiprazole & Olanzapine

So in our next section now, we’ll talk about the use of LAIs in clinical practice, specifically formulations of aripiprazole and olanzapine. So we’ll begin talking about these two second-generation agent LAIs.

We’ll begin with aripiprazole monohydrate, also known as Abilify Maintena. The typical starting dose is 300 to 400 mg monthly given by deltoid or gluteal injection. Oral supplementation should be continued for 14 days. And the typical maintenance dose is essentially the same as the starting dose, 300 mg to 400 mg every three to four weeks.

In terms of dose equivalency, 10 mg of oral aripiprazole corresponds to approximately 300 mg of LAI every month and doses at or above 15 mg a day of oral aripiprazole would correspond to an LAI dose of 400 mg per month.

If there is a delay or a missed dose that exceeds five to six weeks, patients should be reinitiated on aripiprazole LAI and also given two weeks of oral supplementation.

Our next formulation is aripiprazole lauroxil or Aristada. The typical starting dose for Aristada is 441, 662 or 882 mg monthly. Oral supplementation should be continued for 21 days after the first injection. And typical maintenance doses for aripiprazole lauroxil are either 441 to 882 mg monthly, 882 mg every six weeks or 1064 mg every two months.

So what does dose equivalence look like here for aripiprazole lauroxil? 10 mg oral aripiprazole corresponds to 440 mg LAI monthly. 15 mg of oral corresponds to either 662 mg per month, 882 mg every six weeks or 1064 mg every two months. And doses at or above 20 mg per day oral aripiprazole would correspond to 882 mg per month.

It’s important to note that the 441 mg dose of aripiprazole lauroxil may be administered either by deltoid or gluteal injection. All other doses are given by gluteal injection.

If a patient has a delayed or missed dose that lasts greater than 12 weeks, again the patient should be reloaded and given one week of oral aripiprazole supplementation.

We also want to talk now about Aristada Initio. Initio is a single dose to either initiate Aristada or reinitiate Aristada following a missed dose. So this is given as Initio 675 mg as a one-time dose by deltoid or gluteal injection and a single dose of 30 mg oral aripiprazole. The first injection of Aristada may be administered on the same day as Initio or up to 10 days thereafter.

And finally, in this section we have olanzapine pamoate or Zyprexa Relprevv. The typical starting doses range from 150 to 405 mg every two to four weeks given by gluteal injection. Oral supplementation should be continued for 14 to 21 days after the first injection. And typical maintenance doses are 150 to 300 mg every two weeks or 300 to 405 mg monthly.

What does dose equivalence look like for olanzapine pamoate? 10 mg oral olanzapine corresponds to either 150 mg every two weeks or 300 mg every four weeks of the LAI. 15 mg oral olanzapine corresponds to either 210 mg every two weeks or 405 mg every four weeks. And doses at or above 20 mg a day would correspond to an LAI dose of 300 mg every two weeks.

An important comment for olanzapine pamoate is that patients must be monitored for three hours post injection and this is a specific requirement for this medication.

So our key points for this section: For Abilify Maintena, the typical starting dose is 300 to 400 mg per month. Oral supplementation is continued for 14 days. And the typical maintenance dose is 300 to 400 mg every three to four weeks.

For Abilify Aristada, the typical starting dose is 441, 662 or 882 mg monthly. Oral supplementation is continued for 21 days. And the typical maintenance dose range is from 441 to 882 mg per month, 882 mg every six weeks or 1064 mg every two months.

For Zyprexa Relprevv, the starting dose is 150, 210, 300 or 405 mg every two to four weeks given by gluteal injection. Oral supplementation is continued for 14 to 21 days. And the typical maintenance dose is 150 to 300 mg every two weeks or 300 to 405 mg monthly