title: Aripiprazole long-acting injection: promising but more evidence needed.
abstract: OBJECTIVE
  Aripiprazole long acting injection (ALAI) is now available, and this paper aims to assist clinicians in deciding when to use ALAI.
  
  
  CONCLUSIONS
  Aripiprazole is a partial dopamine agonist with low sedation, relatively favourable metabolic profile and a tendency to lower, rather than raise, prolactin. Available for over a decade, aripiprazole has been increasingly recognised by many clinicians as a useful option in the treatment of psychoses. ALAI is a suspension of crystalline aripiprazole in water which takes 5-7 days to reach steady state after an initial intramuscular injection. Monthly injections achieve steady state in four months. Studies have demonstrated that ALAI is effective in aripiprazole-responsive patients. ALAI was generally well tolerated, but more prone to cause extrapyramidal side-effects than the oral form. ALAI has not been compared with other depots. Although the recommended starting dose is 400 mg, it is likely that there will be significant inter-individual dose variation. Dose optimisation in each patient will be necessary for best effectiveness and tolerability. ALAI is currently appropriate for aripiprazole-responsive patients who need a depot, but clinicians are likely to try ALAI in patients who have been on other depots, particularly in whom weight gain and hyperprolactinaemia have been problematic.
authors.affiliation: Professor, Monash University and Centre of Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia nicholas.keks@monash.edu.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Keks
authors.affiliation: Senior Lecturer, Monash University, Eastern Health and Centre of Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Hope
authors.affiliation: Pharmacist, Psychotropic Drug Advisory Service at the Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Culhane
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000068180:Aripiprazole / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced; D007273:Injections, Intramuscular; D012559:Schizophrenia / Q000188:drug therapy*; D015430:Weight Gain / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D000068180:Aripiprazole
keywords: aripiprazole long-acting injection; depots; pharmacotherapy; schizophrenia