Abilify Maintena (aripiprazole extended release)

Brand name: Abilify Maintena^®.
Active ingredient name: Aripiprazole.
Type of medication: Atypical antipsychotic.
Available in Canada from: Otsuka and Lundbeck Alliance.
Form: Long-acting depot injection.
Generic: No.
Listed on Ontario formulary: Yes (with suggested criteria for coverage*).
*This product has a therapeutic note, which suggests a physician should prescribe it for the treatment of schizophrenia in individuals with a history of non-adherence and either
(1) inadequate control or significant side effects from 2 or more oral antipsychotics including at least one atypical or
(2) inadequate control or significant side effects from one or more typical depot antipsychotics.
What this means is that for most individuals with schizophrenia, Abilify Maintena will not be a first-line medication choice. Each physician will assess the use of this medication on a case-by-case basis. If this medication is deemed appropriate for you it will be covered by the Ontario Drug Benefit program.
Abilify^® Maintena^® is also available in tablet form called Abilify^®.
OHIP+ coverage: Yes (with suggested criteria for coverage*).
 
*This product has a therapeutic note, which suggests a physician should prescribe it for the treatment of schizophrenia in individuals with a history of non-adherence and either
(1) inadequate control or significant side effects from 2 or more oral antipsychotics including at least one atypical or
(2) inadequate control or significant side effects from one or more typical depot antipsychotics.

What is Abilify Maintena used for?

Abilify Maintena is used as maintenance treatment for the symptoms of schizophrenia and other psychotic disorders in adults. It may also be used to treat other conditions such as bipolar disorder. Talk to your doctor to understand why you are taking Abilify Maintena.

How should I take Abilify Maintena?

Abilify Maintena is a long-acting depot injection. It is an intramuscular injection. It must be administered by a healthcare provider, most often a nurse. You may receive the injection in a clinic, in a hospital, in your doctor’s office or in your home. The injection is usually given once every 4 weeks. 
 
Abilify Maintena injection is available as a 300 mg/vial and 400 mg/vial dose in Canada. The usual initial and maintenance dose for schizophrenia and other psychotic illnesses is 400 mg every 4 weeks. When you are just beginning Abilify Maintena you may receive oral therapy with Abilify Maintena or another oral antipsychotic with the initial injection. You will likely continue with the oral medication for about 14 days, to allow the depot medication to get into your system and begin to work. After 14 days the oral medication will likely be stopped and you will be maintained on an injection every 4 weeks.

What are the common side effects of Abilify Maintena?

The most common side effects of Abilify Maintena include:

• Feeling of restlessness (akathisia)
• Headache
• Abnormal movements (extrapyramidal side effects)
• Nausea, vomiting, upset stomach
• Insomnia
• Constipation
• Anxiety
• Pain at injection site

What are rare but potentially serious side effects seen with Abilify Maintena?

• Decrease in white blood cell count (agranulocytosis)
• Cerebrovascular event (stroke)
• Anaphylactic reaction (severe allergy)
• Diabetic ketoacidosis (DKA)
• Neuroleptic malignant syndrome (NMS)

Warnings/Precautions

New information has become available from the U.S. Food and Drug Administration to suggest that some individuals taking Abilify Maintena may experience compulsive or uncontrollable urges to gamble, binge eat, shop and have sex. These urges were reported to have stopped when the dose of the medication was reduced or the medication was discontinued. These impulse-control problems or urges are rare, however, it important to inform your physician if you or a family member/friend experience any of these urges while taking Abilify Maintena. 
 
More information on this topic can be found at: http://www.fda.gov/Drugs/DrugSafety/ucm498662.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery
 
Older adults with dementia-related psychosis treated with antipsychotic medication are at an increased risk of death compared to individuals not receiving antipsychotics. Most deaths appear to be either cardiovascular or infectious. Abilify Maintena is not approved for the treatment of dementia-related psychosis. Some individuals with dementia may, however, be treated with this medication. Discuss the potential risks and benefits of this medication with your doctor for this indication.

What medications interact with Abilify Maintena?

Tell all your doctors, pharmacists and dentists that you are taking Abilify Maintena. You should also tell your doctor or pharmacist if you are taking any other medications, including those obtained without a prescription, and herbal and vitamin products. When the levels of a medication are increased or decreased in your bloodstream, this can affect the medication’s efficacy and safety.
 
The following medications might increase the levels of Abilify Maintena in your bloodstream:

• Ketoconazole (anti-fungal)
• Quinidine (anti-arrhythmic)

 
The following medications might decrease the levels of Abilify Maintena in your bloodstream:

• Carbamazepine (anti-convulsant)
• St. John’s Wort (herbal medication)

 
 The following types of medications may interact with Abilify Maintena:

• Anti-Parkinson agents (dopamine agonists)
• Certain medications for allergies (e.g., Benadryl [diphenhydramine])
• Certain medications for sleep (e.g., lorazepam, zopiclone)
• Certain medications for pain (e.g., fentanyl)