Optimizing Treatment With Aripiprazole Monohydrate: Pharmacokinetic Advantages of Long-Acting Injectable...

Schizophrenia and bipolar I disorder (BP-I) are chronic, disabling psychiatric illnesses marked by high morbidity, elevated mortality, and functional deterioration, often exacerbated by poor adherence to oral antipsychotic medications. Long-acting injectable (LAI) antipsychotics were developed to address adherence challenges and have demonstrated clinical benefits including reduced non-adherence and relapse rates, fewer hospitalizations, and improved functioning and quality of life, and reduced mortality risk. Among available LAIs, aripiprazole offers a unique pharmacologic profile as the only partial dopamine agonist available in an LAI formulation. Aripiprazole monohydrate LAI is available as a once monthly and a once-every-two-month formulation. In this consensus panel report, five psychiatric experts convened to evaluate the pharmacokinetic properties, safety, efficacy, and clinical utility of aripiprazole monohydrate LAIs in the treatment of schizophrenia and BP-I. The panel focused particularly on the more recently approved once-every-2-month ready-to-use formulation. This article summarizes the evidence reviewed by the panel and highlights key considerations for optimizing the use of aripiprazole monohydrate LAIs in clinical practice to enhance treatment outcomes in patients with schizophrenia and BP-I.