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Pharmacokinetic Evaluation of a 1-Day Treatment Initiation Option for Starting Long-Acting Aripiprazole Lauroxil for Schizophrenia
Open accessAbstract
Background: Aripiprazole lauroxil (AL), a long-acting injectable antipsychotic for the treatment of schizophrenia, requires 21 days of oral aripiprazole supplementation upon initiation. We report findings from a phase 1 study investigating a nanocrystalline milled dispersion of AL (AL NCD) as a potential 1-day initiation regimen. The 1-day initiation regimen is designed to enable rapid achievement of plasma aripiprazole concentrations that are comparable with the 21-day oral initiation regimen. Here, a 6-month pharmacokinetic study compared 2 different initiation regimens for starting AL. Methods: Patients were randomized 1:1:1:1 to receive 1 of 4 treatments consisting of the 1-day (single AL NCD injection + one 30-mg dose of oral aripiprazole on day 1 only) or the 21-day (15-mg daily dose of oral aripiprazole for 21 days) initiation regimen, each combined with a starting AL dose of either 441 mg or 882 mg. Results: In total, 133/161 patients completed the study. The pharmacokinetic profile of the 1-day initiation regimen was comparable to the 21-day initiation regimen; both achieved aripiprazole concentrations in the therapeutic range within 4 days and remained in a comparable concentration range during treatment initiation. Common adverse events (≥5.0%) were injection-site pain, headache, increased weight, insomnia, dyspepsia, and anxiety. Nine akathisia events occurred (4 events in 4 patients and 5 events in 2 patients in the 1-day and 21-day initiation regimen groups, respectively). Conclusions: The 1-day initiation regimen resulted in plasma aripiprazole concentrations consistent with the 21-day initiation regimen. Therefore, a single dose of AL NCD with a single 30-mg oral dose of aripiprazole provides an alternative initiation regimen for starting AL.
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“When aripiprazole lauroxil was first approved, oral supplementation with aripiprazole was recommended for 21 days following initiation [63, 68].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [68]
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Correll, C. U., Kim, E., Sliwa, J. K., Hamm, W., Gopal, S., Mathews, M., Venkatasubramanian, R., & Saklad, S. R. (2021) · CNS Drugs · doi:10.1007/s40263-020-00779-5 · Cited by 205
Metadata
- Authors
- Hard, M. L., Wehr, A. Y., Du, Y., Weiden, P. J., Walling, D., & von Moltke, L.
- Affiliations
- Alkermes (United States) (US)
- Collaborative Neuroscience Network (US)
- Alkermes, Inc, Waltham, MA; and
- Corresponding author
- Hard, Marjie L.
- Wehr, Angela Y.
- Du, Yangchun
- Weiden, Peter J.
- Venue
- Journal of Clinical Psychopharmacology
- Published
- 2018-10
- Volume
- 38
- Issue
- 5
- Pages
- 435-441
- ISSN
- 0271-0749 (ISSN-L)
- 1533-712X
- PMC
- PMC6133194
- OpenAlex
- W2883349192
- Cited by
- 17
- References
- 21
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 2 · 2021: 4 · 2020: 2 · 2019: 3 · 2018: 1
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Psychopharmacology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Keywords
- aripiprazole lauroxil, long-acting injectable antipsychotics, schizophrenia, pharmacokinetics, akathisia, injection site pain
- MeSH terms
- Aripiprazole, Administration, Oral, Adult, Delayed-Action Preparations, Double-Blind Method, Drug Administration Schedule, Female, Humans, Injections, Intramuscular, Male, Middle Aged, Schizophrenia, Antipsychotic Agents, Treatment Outcome
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