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07. LAIs in Practice: Aripiprazole & Olanzapine

Published on June 1, 2025 Certification expiration date: June 1, 2028

Brian Miller, M.D., Ph.D., M.P.H.

Professor - Augusta University

Key Points

Aripiprazole monohydrate (Abilify Maintena) requires 14 days of oral supplementation after initiation, with typical doses of 300-400mg monthly.
Aripiprazole lauroxil (Aristada) offers flexible dosing intervals up to 2 months, with required 21-day oral supplementation after first injection.
Olanzapine pamoate (Zyprexa Relprevv) requires 3-hour post-injection monitoring and offers dosing options of every 2 or 4 weeks.

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Slides and Transcript

Slide 1 of 15

So in our next section now, we’ll talk about the use of LAIs in clinical practice, specifically formulations of aripiprazole and olanzapine. So we’ll begin talking about these two second-generation agent LAIs.

LAIs in Practice: Aripiprazole & Olanzapine Slide 1 of 15

Slide 2 of 15

We’ll begin with aripiprazole monohydrate, also known as Abilify Maintena. The typical starting dose is 300 to 400 mg monthly given by deltoid or gluteal injection. Oral supplementation should be continued for 14 days. And the typical maintenance dose is essentially the same as the starting dose, 300 mg to 400 mg every three to four weeks.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 2 of 15

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Slide 3 of 15

In terms of dose equivalency, 10 mg of oral aripiprazole corresponds to approximately 300 mg of LAI every month and doses at or above 15 mg a day of oral aripiprazole would correspond to an LAI dose of 400 mg per month.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 3 of 15

Slide 4 of 15

If there is a delay or a missed dose that exceeds five to six weeks, patients should be reinitiated on aripiprazole LAI and also given two weeks of oral supplementation.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 4 of 15

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Slide 5 of 15

Our next formulation is aripiprazole lauroxil or Aristada. The typical starting dose for Aristada is 441, 662 or 882 mg monthly. Oral supplementation should be continued for 21 days after the first injection. And typical maintenance doses for aripiprazole lauroxil are either 441 to 882 mg monthly, 882 mg every six weeks or 1064 mg every two months.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 5 of 15

Slide 6 of 15

So what does dose equivalence look like here for aripiprazole lauroxil? 10 mg oral aripiprazole corresponds to 440 mg LAI monthly. 15 mg of oral corresponds to either 662 mg per month, 882 mg every six weeks or 1064 mg every two months. And doses at or above 20 mg per day oral aripiprazole would correspond to 882 mg per month.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

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Slide 7 of 15

It’s important to note that the 441 mg dose of aripiprazole lauroxil may be administered either by deltoid or gluteal injection. All other doses are given by gluteal injection.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 7 of 15

Slide 8 of 15

If a patient has a delayed or missed dose that lasts greater than 12 weeks, again the patient should be reloaded and given one week of oral aripiprazole supplementation.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 8 of 15

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Slide 9 of 15

We also want to talk now about Aristada Initio. Initio is a single dose to either initiate Aristada or reinitiate Aristada following a missed dose. So this is given as Initio 675 mg as a one-time dose by deltoid or gluteal injection and a single dose of 30 mg oral aripiprazole. The first injection of Aristada may be administered on the same day as Initio or up to 10 days thereafter.

References:

Ehret, M. J., Davis, E., Luttrell, S. E., & Clark, C. (2018). Aripiprazole Lauroxil NanoCrystal® Dispersion Technology (Aristada Initio®). Clinical Schizophrenia & Related Psychoses, 12(2), 92–96. https://doi.org/10.3371/CSRP.EHDA071918

LAIs in Practice: Aripiprazole & Olanzapine Slide 9 of 15

Slide 10 of 15

And finally, in this section we have olanzapine pamoate or Zyprexa Relprevv. The typical starting doses range from 150 to 405 mg every two to four weeks given by gluteal injection. Oral supplementation should be continued for 14 to 21 days after the first injection. And typical maintenance doses are 150 to 300 mg every two weeks or 300 to 405 mg monthly.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 10 of 15

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Slide 11 of 15

What does dose equivalence look like for olanzapine pamoate? 10 mg oral olanzapine corresponds to either 150 mg every two weeks or 300 mg every four weeks of the LAI. 15 mg oral olanzapine corresponds to either 210 mg every two weeks or 405 mg every four weeks. And doses at or above 20 mg a day would correspond to an LAI dose of 300 mg every two weeks.

References:

Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. The American Journal of Psychiatry, 167(6), 686-693. https://doi.org/10.1176/appi.ajp.2009.09060802
McAdam, M. K., Baldessarini, R. J., Murphy, A. L., & Gardner, D. M. (2023). Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). Journal of Psychopharmacology, 37(10), 982-991. https://doi.org/10.1177/02698811231205688

LAIs in Practice: Aripiprazole & Olanzapine Slide 11 of 15

Slide 12 of 15

An important comment for olanzapine pamoate is that patients must be monitored for three hours post injection and this is a specific requirement for this medication.

References:

Rozema, J., van Stee, C. P., Touw, D. J., & van Meurs, M. (2025). Olanzapine; Postinjection Syndrome; Pharmacokinetics in View: Grand Round/A Case Study. Therapeutic Drug Monitoring. Advance online publication. https://doi.org/10.1097/FTD.0000000000001317
Podgorná, G., Albrecht, J., Buday, J., Mareš, T., Le, T. H., Kališová, L., & Anders, M. (2022). Post-Injection Delirium/Sedation Syndrome: A case report and 2-year follow-up. The American Journal of Case Reports, 23, e937579. https://doi.org/10.12659/AJCR.937579

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Slide 13 of 15

So our key points for this section: For Abilify Maintena, the typical starting dose is 300 to 400 mg per month. Oral supplementation is continued for 14 days. And the typical maintenance dose is 300 to 400 mg every three to four weeks.

LAIs in Practice: Aripiprazole & Olanzapine Slide 13 of 15

Slide 14 of 15

For Abilify Aristada, the typical starting dose is 441, 662 or 882 mg monthly. Oral supplementation is continued for 21 days. And the typical maintenance dose range is from 441 to 882 mg per month, 882 mg every six weeks or 1064 mg every two months.

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Slide 15 of 15

For Zyprexa Relprevv, the starting dose is 150, 210, 300 or 405 mg every two to four weeks given by gluteal injection. Oral supplementation is continued for 14 to 21 days. And the typical maintenance dose is 150 to 300 mg every two weeks or 300 to 405 mg monthly

LAIs in Practice: Aripiprazole & Olanzapine Slide 15 of 15

Next Section

08. LAIs in Practice: Paliperidone & Risperidone

Learning Objectives:

After completing this activity, the learner will be able to:

Identify appropriate candidates for long-acting injectable (LAI) antipsychotics.
Compare the clinical benefits of LAI antipsychotics versus oral medications.
Describe the pharmacological characteristics of different LAI antipsychotic formulations, including dosing intervals, administration requirements, and oral supplementation needs for various first and second-generation agents.

Original Release Date: June 1, 2025

Expiration Date: June 1, 2028

Expert: Brian Miller, M.D.

Medical Editor: Flavio Guzmán, M.D.

Relevant Financial Disclosures:

Brian Miller declares the following interests:

- Bristol Myers Squibb: Data Safety Monitoring Board

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

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Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.