8 Things You Should Know About the Once-Monthly Abilify Maintena Injection

Convenience, effectiveness, and affordability. Whether it’s a short-term course of antibiotics or a long-term maintenance medication, these are three things that most of us want when we’re finding a medication for the situation we’re going through. Antipsychotic medications are no exception.

When possible, one way to prioritize convenience and adherence is by swapping out a daily oral antipsychotic for a long-lasting equivalent. So if you take oral Abilify (aripiprazole), a longer-lasting alternative like Abilify Maintena may seem enticing.

This once-monthly Abilify injection is a helpful option for many people living with bipolar disorder or schizophrenia. But there are several things to keep in mind if you’re looking to start taking it.

1. What is the Abilify Maintena injection?

Abilify Maintena (aripiprazole) is an injectable medication that’s FDA approved to treat bipolar disorder and schizophrenia in adults.

This medication falls into a group of medications called atypical antipsychotics. The specific way it works isn’t fully known, but it’s thought to impact dopamine and serotonin levels in your brain. Hormones like these are thought to be centrally involved in bipolar disorder and schizophrenia.

Important: Medications like Abilify Maintena don’t change who you are. They aim to encourage a positive mood and healthy changes in thoughts and behavior.

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2. How is Abilify Maintena administered?

Abilify Maintena is given as an injection into your muscle. This is called an intramuscular (IM) injection. It’s injected once a month by a healthcare professional.

Before you start receiving your monthly Abilify injections, there are a few initial steps to follow:

1. Take oral Abilify for 2 weeks. If you’ve never taken oral Abilify before, you’ll need to do that first. It’s recommended to take oral Abilify daily for up to 2 weeks to make sure your body tolerates it.

2. Start injectable Abilify. If you don’t experience any bad side effects after trying out oral Abilify, you can receive your initial 400 mg dose of Abilify Maintena.

3. Continue oral therapy for an additional 2 weeks. After this first injection, there’s still work to do. Abilify Maintena takes some time to kick-in, so you should keep taking oral Abilify (or another antipsychotic medication) every day for 2 more weeks.

After these initial steps are complete, make a point to schedule your next Abilify Maintena dose 1 month (4 weeks) after your first one. If you can’t make an appointment on the exact day each month, that’s OK. At a minimum, each dose should be spaced apart by at least 26 days. Try not  to go more than 5 to 6 weeks between each injection.

Where do you inject Abilify Maintena?

You can’t inject Abilify Maintena yourself. It should be administered by a healthcare professional. They should schedule injection appointments with you every month. Once you’ve made it to their office or clinic, they will slowly administer the injection as a single dose in your buttock or upper arm.

Once they’re done, try your best to avoid rubbing or massaging the area of skin where it was injected. This can affect the medication’s effectiveness.

3. How long does it take the once-monthly Abilify injection to work?

Abilify Maintena doesn’t start working right away. It’s an extended-release (ER) version of aripiprazole, so it’s designed to work for a long time. It’s not meant to provide quick relief. It takes a few weeks to start working. This is why you should keep taking an oral antipsychotic for 2 weeks after your first dose of Abilify Maintena.

A faster-acting Abilify injection is available, but it’s used differently. It’s an as-needed IM injection that starts working much quicker than Abilify Maintena. It treats acute (short-term) agitation from bipolar disorder or schizophrenia.

4. How long does the once-monthly Abilify injection last?

Abilify Maintena lasts longer in your body than oral Abilify. Each dose lasts for about a month.

That doesn’t mean Abilify Maintena completely leaves your body after 1 month. After receiving one injection, it can take around 150 days (5 months) for the medication to completely leave your system. If you’ve received several injections, it may take up to 7 or 8 months. However, specific timeframes can vary by person.

5. What Abilify injection side effects should you expect?

Compared to oral Abilify, some side effects are less likely to happen with the Abilify injection, such as stomach upset. But like all medications, it still has a number of side effects to keep in mind. The most common ones include:

• Soreness at the injection site

• Constipation

• Trouble sitting or standing still

• Feeling tired

• Blood sugar changes

• Higher cholesterol

• Weight gain

If you experience any unmanageable side effects from Abilify Maintena 400 mg, your healthcare provider may decide to lower your monthly dose to 300 mg.

Serious once-monthly Abilify injection side effects

Although rare, more serious side effects are also possible. One of Abilify Maintena’s most serious risks has a boxed warning — the FDA’s most serious type of medication warning. Older adults with dementia-related psychosis who use antipsychotics like Abilify Maintena have a higher risk of death.

Other rare but serious side effects include:

• Strokes or mini-strokes in older adults with dementia

• Significant changes in blood sugar, cholesterol, or body weight

• Strong urges to gamble or perform risky behaviors

• Dehydration and trouble regulating body heat

• Large changes in white blood cell counts

• Low blood pressure when changing positions

• Higher risk of falling down

• Higher risk for seizures for people living with epilepsy

• Neuroleptic malignant syndrome, a dangerous condition caused by rapidly-dropping dopamine levels

• Tardive dyskinesia, a serious movement disorder

When should you contact your healthcare provider about side effects from Abilify Maintena Injections?

Some of the most common side effects of Abilify Maintena, such as constipation and injection site soreness, should get better with time. But it’s still a good idea to contact your healthcare provider if any side effects are bothering you.

Some side effects are more serious. If you’re experiencing signs of any rare side effects from Abilify Maintena, contact your healthcare provider right away. But if any symptoms feel severe or life threatening, it’s better to go to the nearest emergency room.

The most important thing is to try and get on top of side effects early. Listening to your body and seeking treatment early on can help ensure there are no long-term complications down the road.

6. How is the once-monthly Abilify injection different from oral Abilify?

Oral Abilify and Abilify Maintena injections contain the same medication — aripiprazole. But there are several differences when it comes to uses, dosages, and more.

7. How does the Abilify injection compare to Aristada and other similar medications?

In addition to traditional Abilify and Abilify Maintena, other types of aripiprazole are available.

Aristada

Aristada (aripiprazole lauroxil) is another long-acting version of aripiprazole ER, similar to Abilify Maintena. It’s given as an IM injection into your buttock or upper arm.

But its uses and dosages are a bit different. Aristada is only approved to treat schizophrenia. It’s not approved to treat bipolar disorder. It also comes in different dosages that allow it to be dosed every month, every 6 weeks (1.5 months), or every 2 months.

If you or a loved one have been using Abilify Maintena to treat schizophrenia without issue, your healthcare provider may talk to you about switching to Aristada for convenience's sake. Or, if you have health insurance, there’s a chance your plan may prefer to cover Aristada over Abilify Maintena (or vice versa).

Aristada Initio

Aristada and Aristada Initio go hand-in-hand. Aristada Initio (aripiprazole lauroxil) is an injectable medication that helps you “initiate” treatment with Aristada.

Aristada Initio is designed to be a one-time medication that helps you start using Aristada. Before you start receiving Aristada injections on their own, your healthcare provider will give you a dose of oral abilify, a dose of Aristada Initio, and a dose of Aristada at the same time. This will help your body respond to Aristada.

Abilify Asimtufii

Abilify Asimtufii (aripiprazole) is very similar to Abilify Maintena. It also has some overlap with Aristada. It was FDA approved in April 2023.

Abilify Asimtufii is a long-acting IM injection that has the same uses as Abilify Maintena. It’s FDA approved to treat bipolar disorder and schizophrenia. But it lasts longer. Abilify Asimtufii is given once every 2 months (56 days) into the buttock — not every month. Available data shows that the two formulations are comparably safe and effective.

If you’re interested in receiving this version of aripiprazole, you’ll need to receive oral Abilify or Abilify Maintena first. You’ll likely be eligible if you’ve successfully taken oral Abilify for 2 weeks or have already had at least one dose of Abilify Maintena.

Abilify MyCite

Unlike Abilify Maintena, Abilify Asimtufii, and Aristada,  Abilify MyCite (aripiprazole tablets with sensor) isn’t an injectable medication. It’s an oral “smart pill” that’s considered a type of digital medicine. It’s approved to treat schizophrenia, bipolar disorder, and depression.

Abilify MyCite is comparable to oral Abilify, but there's a small, digestible tracker inside of it. The tracker works with a secure app on your smartphone that keeps track of when you take each dose and how you’re feeling. If you so choose, you can share this data with your healthcare team or loved ones to keep them informed with how you’re doing.

8. Are there ways to save on Abilify Maintena?

Yes. There are ways to save money on Abilify Maintena, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs (PAPs) and copay savings cards to save money on your prescription.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Abilify Maintena’s PAP, which offers the medication free of cost.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $10 per month for Abilify Maintena using a savings card from the manufacturer.

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Written by:

Crystal Akpede, PharmD Candidate

Crystal currently works as a pharmacy intern at a community outpatient pharmacy located within a health clinic. During pharmacy school, Crystal also served as the secretary for her campus’ chapter of the pharmaceutical fraternity Kappa Psi and the Student National Pharmaceutical Association.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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