Ultra-High-Dose Long-Acting Injectable Aripiprazole in Chronic Refractory Schizophrenia: A Case Report

An intramuscular long-acting injectable (LAI) aripiprazole administered once a month as a single injection into the gluteal muscle is increasingly appreciated in the course of a long-term maintenance treatment of schizophrenia. Due to efficacy in delaying and decreasing relapse, low rates of feared side effects including extrapyramidal, metabolic and cardiovascular disturbances, aripiprazole LAI has the potential to significantly improve adherence. According to the prescribing information, the maximal starting as well as maintenance dose of aripiprazole LAI is restricted to 400 mg following a 26-day interval between the single doses. We present a case of a 72-year-old female inpatient with an acute exacerbation of chronic refractory schizophrenia treated with aripiprazole LAI (ABILIFY MAINTENA) beyond the officially approved dose range (up to 1200 mg per month). Applying this ultra-high-dose antipsychotic maintenance treatment over 12 weeks, we observed a clinically meaningful reduction of the initially severe psychopathological phenomena with primarily positive symptoms (a total-score reduction from 111 to 75 on the Positive and Negative Syndrome Scale; PANSS). Despite multi-morbidity and rather advanced age of the patient, no objectifiable adverse events, which were measured by The Dosage Record Treatment Emergent Symptom Scale (DOTES) and The Barnes Akathisia Rating Scale (BARS), occurred during the treatment. Our safe experience with an almost threefold higher monthly dose might encourage researchers to further investigate the efficacy, tolerability as well as handling of highly dosed aripiprazole LAI as a maintenance treatment option in refractory schizophrenia.