February 8, 2016
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Abilify Maintena

"July 10, 2015 -- People with schizophrenia are three times more likely to smoke than those who don't have the mental health condition, a study published in Lancet Psychiatry says.

Experts at King's College London say that although li"...

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Abilify Maintena




Side Effects
Interactions

SIDE EFFECTS

The following adverse reactions are discussed in more detail in other sections of the labeling:

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Safety Database of ABILIFY MAINTENA and Oral Aripiprazole

Oral aripiprazole has been evaluated for safety in 16,114 adult patients who participated in multiple-dose, clinical trials in schizophrenia and other indications, and who had approximately 8,578 patient-years of exposure to oral aripiprazole. A total of 3,901 patients were treated with oral aripiprazole for at least 180 days, 2,259 patients were treated with oral aripiprazole for at least 360 days, and 933 patients continuing aripiprazole treatment for at least 720 days.

ABILIFY MAINTENA has been evaluated for safety in 2,188 adult patients in clinical trials in schizophrenia, with approximately 2,646 patient-years of exposure to ABILIFY MAINTENA. A total of 1,230 patients were treated with ABILIFY MAINTENA for at least 180 days (at least 7 consecutive injections) and 935 patients treated with ABILIFY MAINTENA had at least 1 year of exposure (at least 13 consecutive injections).

The conditions and duration of treatment with ABILIFY MAINTENA included double-blind and open-label studies. The safety data presented below are derived from the 12-week double-blind placebo-controlled study of ABILIFY MAINTENA in adult patients with schizophrenia.

Adverse Reactions with ABILIFY MAINTENA

Most Commonly Observed Adverse Reactions in Double-Blind, Placebo-Controlled Clinical Trials in Schizophrenia

Based on the placebo-controlled trial of ABILIFY MAINTENA in schizophrenia, the most commonly observed adverse reactions associated with the use of ABILIFY MAINTENA in patients (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) were increased weight (16.8% vs 7.0%), akathisia (11.4% vs 3.5%), injection site pain (5.4% vs 0.6%) and sedation (5.4% vs 1.2%).

Commonly Reported Adverse Reactions in Double-Blind, Placebo-Controlled Clinical Trials in Schizophrenia

The following findings are based on the double-blind, placebo-controlled trial that compared ABILIFY MAINTENA 400 mg or 300 mg to placebo in patients with schizophrenia. Table 7 lists the adverse reactions reported in 2% or more of ABILIFY MAINTENA-treated subjects and at a greater proportion than in the placebo group.

Table 7: Adverse Reactions in ≥ 2% of ABILIFY MAINTENA-Treated Adult Patients with Schizophrenia in a 12-Week Double-Blind, Placebo- Controlled Triala

System Organ Class
Preferred Term
Percentage of Patients Reporting Reactiona
ABILIFY MAINTENA
(n=167)
Placebo
(n=172)
Gastrointestinal Disorders
  Constipation 10 7
  Dry Mouth 4 2
  Diarrhea 3 2
  Vomiting 3 1
  Abdominal Discomfort 2 1
General Disorders and Administration Site Conditions
  Injection Site Pain 5 1
Infections and Infestations
  Upper Respiratory Tract Infection 4 2
Investigations
  Increased Weight 17 7
  Decreased Weight 4 2
Musculoskeletal And Connective Tissue Disorders
  Arthralgia 4 1
  Back Pain 4 2
  Myalgia 4 2
  Musculoskeletal Pain 3 1
Nervous System Disorders
  Akathisia 11 4
  Sedation 5 1
  Dizziness 4 2
  Tremor 3 1
Respiratory, Thoracic And Mediastinal
  Nasal Congestion 2 1
a This table does not include adverse reactions which had an incidence equal to or less than placebo.

Other Adverse Reactions Observed During the Clinical Trial Evaluation of ABILIFY MAINTENA

The following listing does not include reactions: 1) already listed in previous tables or elsewhere in labeling, 2) for which a drug cause was remote, 3) which were so general as to be uninformative, 4) which were not considered to have significant clinical implications, or 5) which occurred at a rate equal to or less than placebo.

Reactions are categorized by body system according to the following definitions: frequent adverse reactions are those occurring in at least 1/100 patients; infrequent adverse reactions are those occurring in 1/100 to 1/1000 patients; rare reactions are those occurring in fewer than 1/1000 patients:

Blood and Lymphatic System Disorders: rare - thrombocytopenia

Cardiac Disorders: infrequent - tachycardia, rare - bradycardia, sinus tachycardia

Endocrine Disorders: rare - hypoprolactinemia

Eye Disorders: infrequent - vision blurred, oculogyric crisis

Gastrointestinal Disorders: infrequent - abdominal pain upper, dyspepsia, nausea, rare - swollen tongue

General Disorders and Administration Site Conditions: frequent - fatigue, injection site reactions (including erythema, induration, pruritus, injection site reaction, swelling, rash, inflammation, hemorrhage), infrequent - chest discomfort, gait disturbance, rare - irritability, pyrexia

Hepatobiliary Disorders: rare - drug induced liver injury

Immune System Disorders: rare - drug hypersensitivity

Infections and Infestations: rare - nasopharyngitis

Investigations: infrequent - blood creatine phosphokinase increased, blood pressure decreased, hepatic enzyme increased, liver function test abnormal, electrocardiogram QT-prolonged, rare - blood triglycerides decreased, blood cholesterol decreased, electrocardiogram T-wave abnormal

Metabolism and Nutrition Disorders: infrequent - decreased appetite, obesity, hyperinsulinemia

Musculoskeletal and Connective Tissue Disorders: infrequent - joint stiffness, muscle twitching, rare - rhabdomyolysis

Nervous System Disorders: infrequent - cogwheel rigidity, extrapyramidal disorder, hypersomnia, lethargy, rare - bradykinesia, convulsion, dysgeusia, memory impairment, oromandibular dystonia

Psychiatric Disorders: frequent - anxiety, insomnia restlessness, infrequent- agitation, bruxism, depression, psychotic disorder, suicidal ideation, rare - aggression, hypersexuality, panic attack

Renal and Urinary Disorders: rare - glycosuria, pollakiuria, urinary incontinence

Vascular Disorders: infrequent - hypertension

Demographic Differences

An examination of population subgroups was performed across demographic subgroup categories for adverse reactions experienced by at least 5% of ABILIFY MAINTENA subjects at least twice rate of the placebo (i.e., increased weight, akathisia, injection site pain, and sedation) in the double-blind placebo-controlled trial. This analysis did not reveal evidence of differences in safety differential adverse reaction incidence on the basis of age, gender, or race alone; however, there were few subjects ≥ 65 years of age.

Injection Site Reactions of ABILIFY MAINTENA

In the data from the short-term, double-blind, placebo-controlled trial with ABILIFY MAINTENA in patients with schizophrenia, the percent of patients reporting any injection site-related adverse reaction (all reported as injection site pain) was 5.4% for patients treated with gluteal administered ABILIFY MAINTENA and 0.6% for placebo. The mean intensity of injection pain reported by subjects using a visual analog scale (0=no pain to 100=unbearably painful) approximately one hour after injection was 7.1 (SD 14.5) for the first injection and 4.8 (SD 12.4) at the last visit in the double-blind, placebo-controlled phase.

In an open-label study comparing bioavailability of ABILIFY MAINTENA administered in the deltoid or gluteal muscle, injection site pain was observed in both groups at approximately equal rates.

Extrapyramidal Symptoms (EPS)

In the short-term, placebo-controlled trial of ABILIFY MAINTENA in adults with schizophrenia, the incidence of reported EPS-related events, excluding events related to akathisia, for ABILIFY MAINTENA-treated patients was 9.6% vs. 5.2% for placebo. The incidence of akathisia-related events for ABILIFY MAINTENA-treated patients was 11.5% vs. 3.5% for placebo.

Dystonia

Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups. In the short-term, placebo-controlled trial of ABILIFY MAINTENA in adults with schizophrenia, the incidence of dystonia was 1.8% for ABILIFY MAINTENA vs. 0.6% for placebo.

Neutropenia

In the short-term, placebo-controlled trial of ABILIFY MAINTENA in adults with schizophrenia, the incidence of neutropenia (absolute neutrophil count ≤ 1.5 thous/μL) for ABILIFY MAINTENA-treated patients was 5.7% vs. 2.1% for placebo. An absolute neutrophil count of < 1 thous/μL (i.e. 0.95 thous/μL) was observed in only one patient on ABILIFY MAINTENA and resolved spontaneously without any associated adverse events [see WARNINGS AND PRECAUTIONS]

Adverse Reactions Reported in Clinical Trials with Oral Aripiprazole

The following is a list of additional adverse reactions that have been reported in clinical trials with oral aripiprazole and not reported above for ABILIFY MAINTENA:

Cardiac Disorders: palpitations, cardiopulmonary failure, myocardial infarction, cardio-respiratory arrest, atrioventricular block, extrasystoles, angina pectoris, myocardial ischemia, atrial flutter, supraventricular tachycardia, ventricular tachycardia

Eye Disorders: photophobia, diplopia, eyelid edema, photopsia

Gastrointestinal Disorders: gastroesophageal reflux disease, swollen tongue, esophagitis, pancreatitis, stomach discomfort, toothache

General Disorders and Administration Site Conditions: asthenia, peripheral edema, chest pain, face edema, angioedema, hypothermia, pain

Hepatobiliary Disorders: hepatitis, jaundice

Immune System Disorders: hypersensitivity

Injury, Poisoning, and Procedural Complications: heat stroke

Investigations: blood prolactin increased, blood urea increased, blood creatinine increased, blood bilirubin increased, blood lactate dehydrogenase increased, glycosylated hemoglobin increased

Metabolism and Nutrition Disorders: anorexia, hyponatremia, hypoglycemia, polydipsia, diabetic ketoacidosis

Musculoskeletal and Connective Tissue Disorders: muscle rigidity, muscular weakness, muscle tightness, decreased mobility, rhabdomyolysis, musculoskeletal stiffness, pain in extremity, muscle spasms

Nervous System Disorders: coordination abnormal, speech disorder, hypokinesia, hypotonia, myoclonus, akinesia, bradykinesia, choreoathetosis

Psychiatric Disorders: loss of libido, suicide attempt, hostility, libido increased, anger, anorgasmia, delirium, intentional self injury, completed suicide, tic, homicidal ideation, catatonia, sleep walking

Renal and Urinary Disorders: urinary retention, polyuria, nocturia

Reproductive System and Breast Disorders: menstruation irregular, erectile dysfunction, amenorrhea, breast pain, gynecomastia, priapism

Respiratory, Thoracic, and Mediastinal Disorders: nasal congestion, dyspnea, pharyngolaryngeal pain, cough

Skin and Subcutaneous Tissue Disorders: rash (including erythematous, exfoliative, generalized, macular, maculopapular, papular rash; acneiform, allergic, contact, exfoliative, seborrheic dermatitis, neurodermatitis, and drug eruption), hyperhidrosis, pruritus, photosensitivity reaction, alopecia, urticaria

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of oral aripiprazole or ABILIFY MAINTENA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: occurrences of allergic reaction (anaphylactic reaction, angioedema, laryngospasm, pruritus/urticaria, or oropharyngeal spasm), pathological gambling, hiccups and blood glucose fluctuation.

Read the Abilify Maintena (aripiprazole extended-release injectable suspension) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

Drugs Having Clinically Important Interactions With ABILIFY MAINTENA

Table 8: Clinically Important Drug Interactions with ABILIFY MAINTENA

Concomitant Drug Name or Drug Class Clinical Rationale Clinical Recommendation
Strong CYP3A4 Inhibitors (e.g., ketoconazole) or strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine) The concomitant use of oral aripiprazole with strong CYP 3A4 or CYP2D6 inhibitors increased the exposure of aripiprazole [see CLINICAL PHARMACOLOGY]. With concomitant use of ABILIFY MAINTENA with a strong CYP3A4 inhibitor or CYP2D6 inhibitor for more than 14 days, reduce the ABILIFY MAINTENA dosage [see DOSAGE AND ADMINISTRATION].
Strong CYP3A4 Inducers (e.g., carbamazepine) The concomitant use of oral aripiprazole and carbamazepine decreased the exposure of aripiprazole [see CLINICAL PHARMACOLOGY]. Avoid use of ABILIFY MAINTENA in combination with carbamazepine and other inducers of CYP3A4 for greater than 14 days [see DOSAGE AND ADMINISTRATION].
Antihypertensive Drugs Due to its alpha adrenergic antagonism, aripiprazole has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly [see WARNINGS AND PRECAUTIONS].
Benzodiazepines (e.g., lorazepam) The intensity of sedation was greater with the combination of oral aripiprazole and lorazepam as compared to that observed with aripiprazole alone. The orthostatic hypotension observed was greater with the combination as compared to that observed with lorazepam alone [see WARNINGS AND PRECAUTIONS]. Monitor sedation and blood pressure. Adjust dose accordingly.

Drugs Having No Clinically Important Interactions With ABILIFY MAINTENA

Based on pharmacokinetic studies with oral aripiprazole, no dosage adjustment of ABILIFY MAINTENA is required when administered concomitantly with famotidine, valproate, lithium, lorazepam [see CLINICAL PHARMACOLOGY].

In addition, no dosage adjustment is necessary for substrates of CYP2D6 (e.g., dextromethorphan, fluoxetine, paroxetine, or venlafaxine), CYP2C9 (e.g., warfarin), CYP2C19 (e.g., omeprazole, warfarin), or CYP3A4 (e.g., dextromethorphan) when co-administered with ABILIFY MAINTENA. Additionally, no dosage adjustment is necessary for valproate, lithium, lamotrigine, lorazepam, or sertraline when co-administered with ABILIFY MAINTENA. [see CLINICAL PHARMACOLOGY].

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 1/28/2016

Side Effects
Interactions

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