An evaluation of aripiprazole long-acting injectable monthly and bimonthly in the maintenance treatment of bipolar I disorder

Bipolar disorder (BD) is a chronic and severe mental disorder with a high risk for recurrence, requiring long-term mood stabilization treatment approaches. The hazards of recurrence in BD include illness progression, decreasing treatment response, chronicity, comorbidity, suicidality, increased health service utilization, and greater direct and indirect economic costs. Treatment nonadherence is one of the most common modifiable deficiencies in the maintenance treatment of BD, which exacerbates the risk of recurrence and unfavorable course and outcome. Aripiprazole is the only dopamine partial agonist that is FDA-approved in a long-acting injectable (LAI) formulation for the maintenance treatment of adults with bipolar I disorder (BD-I), offered as both a once-monthly and bimonthly monohydrate. Herein, we synthesize the results supporting the efficacy, safety, and tolerability of both aripiprazole LAI formulations in BD-I. A narrative search was conducted by an expert opinion in the field, as well as targeted bibliographic searching. Both aripiprazole LAI formulations were established as efficacious in the reduction of manic and mixed episodes in adults with BD-I; however, their efficacy for bipolar depression prevention remains unproven. Aripiprazole LAI is well tolerated and safe, with injection site pain, sedation, weight increase, and akathisia being the most common adverse events.