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Peer-reviewedCC BY-NC 4.0Clinical Psychopharmacology and Neuroscience

Two-injection Start Strategy of Aripiprazole Once-monthly Injection: Current Evidence and Clinical Implications

  • Hayeon Kim1
  • Kyung Ho Lee2,3
  • Changsu Han4
  • Ashwin A. Patkar5,6
  • Prakash S. Masand7
  • Chi-Un Pae1,3
7 affiliations
  1. 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
  2. 2Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
  3. 3Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
  4. 4Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
  5. 5Avance Psychiatry at Centers of Excellence, Raleigh, NC, USA
  6. 6Rush University Medical Center, Chicago, IL, USA
  7. 7Duke-NUS Medical School, Singapore
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Abstract

Long-acting injectable antipsychotics (LAIs) are developed to overcome the limitations of oral antipsychotics (APs) and their use has been increasing in the treatment of various psychiatric disorders such as schizophrenia and bipolar disorder. LAIs are convenient to use and they were also found to enhance treatment adherence and continuation, leading to better clinical outcomes. Aripiprazole (ARP), a partial D2/5-HT1A receptor agonist, has been considered to have fewer adverse events than preexisting APs in terms of metabolic disturbance, sexual dysfunction, and mood instability. In this context, a once-monthly LAI formulation, aripiprazole once-monthly (AOM) has also been developed, and it is widely used in the real-world practice. However, it needs concurrent oral ARP administration for 14 days upon initiation, which may limit its practical use in routine practice due to the complexity of the regimen. Recently, the AOM two-injection start (TIS) strategy has been introduced, which allows rapid achievement of therapeutic plasma concentrations and stable drug levels without the need for a 2-week administration of oral ARP. This strategy may simplify treatment initiation with AOM as well as facilitate smoother transition from oral ARP to AOM in routine practice. Hence, this paper reviews the pharmacological basis, clinical evidence, clinical implications, and future prospects of the AOM TIS strategy in naturalistic treatment settings.

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Cite

BibTeXRIS
BibTeX
@article{kim2026twoinjection,
  title = {{Two-injection Start Strategy of Aripiprazole Once-monthly Injection: Current Evidence and Clinical Implications}},
  author = {Hayeon Kim and Kyung Ho Lee and Changsu Han and Ashwin A. Patkar and Prakash S. Masand and Chi-Un Pae},
  journal = {Clinical Psychopharmacology and Neuroscience},
  year = {2026},
  month = jul,
  doi = {10.9758/cpn.25.1387},
  url = {https://doi.org/10.9758/cpn.25.1387},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Two-injection Start Strategy of Aripiprazole Once-monthly Injection: Current Evidence and Clinical Implications
AU  - Hayeon Kim
AU  - Kyung Ho Lee
AU  - Changsu Han
AU  - Ashwin A. Patkar
AU  - Prakash S. Masand
AU  - Chi-Un Pae
PY  - 2026
DA  - 2026/07/01
JO  - Clinical Psychopharmacology and Neuroscience
DO  - 10.9758/cpn.25.1387
UR  - https://doi.org/10.9758/cpn.25.1387
AB  - Long-acting injectable antipsychotics (LAIs) are developed to overcome the limitations of oral antipsychotics (APs) and their use has been increasing in the treatment of various psychiatric disorders such as schizophrenia and bipolar disorder. LAIs are convenient to use and they were also found to enhance treatment adherence and continuation, leading to better clinical outcomes. Aripiprazole (ARP), a partial D2/5-HT1A receptor agonist, has been considered to have fewer adverse events than preexisting APs in terms of metabolic disturbance, sexual dysfunction, and mood instability. In this context, a once-monthly LAI formulation, aripiprazole once-monthly (AOM) has also been developed, and it is widely used in the real-world practice. However, it needs concurrent oral ARP administration for 14 days upon initiation, which may limit its practical use in routine practice due to the complexity of the regimen. Recently, the AOM two-injection start (TIS) strategy has been introduced, which allows rapid achievement of therapeutic plasma concentrations and stable drug levels without the need for a 2-week administration of oral ARP. This strategy may simplify treatment initiation with AOM as well as facilitate smoother transition from oral ARP to AOM in routine practice. Hence, this paper reviews the pharmacological basis, clinical evidence, clinical implications, and future prospects of the AOM TIS strategy in naturalistic treatment settings.
SN  - 1738-1088
SN  - 2093-4327
ER  -