Raising the Bar: Abilify Maintena’s New Dosing Option and the Real-World Cost of Missed Opportunities

Raising the Bar: Abilify Maintena’s New Dosing Option and the Real-World Cost of Missed Opportunities

In ACT psychiatry, our clients don’t live in tidy medication algorithms or textbook timelines. They live in uncertainty—navigating unstable housing, fluctuating insight, and barriers at every level of the system. The work we do is urgent, and often, we don’t get a second chance. When a client agrees to treatment, the medication must be in hand, at the right dose, ready to go.

That’s why Otsuka’s recent FDA approval of a new loading dose option for Abilify Maintena is more than just a regulatory update—it’s a clinically meaningful change that reflects real-world understanding. Providers in Europe have long been using two 400mg injections of Maintena on day one—a strategy that accelerates therapeutic blood levels and eliminates the need for oral overlap. Now, we finally have that option in the U.S.—and just as important, Otsuka is supporting the rollout with samples so that front-line providers can use it right away.

This isn’t just smart science—it’s a commitment to care.

Recently, I had a client who had been psychiatrically stable for over a year on Invega Sustenna. But she began developing oculogyric crises—involuntary upward eye movements likely related to dopamine blockade. These episodes were distressing and disruptive, and she was understandably reluctant to continue. Rather than risk destabilization by switching her to an oral antipsychotic, we discussed a transition to Abilify Maintena using the new two-dose protocol. I had the samples ready, and we administered both injections during the visit.

That was several weeks ago. Her symptoms have resolved. She remains psychiatrically stable. She just started a new job.

That outcome didn’t happen because of luck—it happened because the medication was there when we needed it, in the right form, backed by a company that gave us the means to act.

Now contrast that with Teva’s rollout of Uzedy, a long-acting risperidone injection utilizing novel SteadyTeq™ delivery technology. Uzedy offers a promising pharmacokinetic profile with monthly and once-every-two-month subcutaneous dosing and does not require oral supplementation at initiation. It has the potential to be a powerful tool—especially for clients who are needle-averse, or who’ve struggled with adherence to older risperidone-based LAIs like Consta.

But that promise means little without access.

Despite multiple attempts, we still cannot get samples of the 200mg and 250mg strengths—the very doses needed to match the higher symptom severity of the clients we see in community psychiatry. The PANSS scores in Uzedy’s trials reflect a different population. In ACT, we’re dealing with individuals whose scores—and lived experiences—are often significantly more severe.

We don’t have time to wait for prior authorizations or shipment delays. Our clients’ willingness to engage is fleeting. When they say “yes,” we need to move—not beg, not fax, not wait. If the necessary dose isn’t in hand, that opportunity may be lost for months. Or longer.

That’s what makes Otsuka’s approach so commendable. They didn’t just obtain the indication—they ensured real-world usability. They put tools in our hands. They respected the urgency of community psychiatry. They understood that we’re not asking for free medication—we’re asking for a fighting chance.

Teva, so far, hasn’t shown that same willingness to meet us where we are.

If a pharmaceutical company wants its medication to be used in the field, they need to understand the field. In ACT, we’re making decisions in parking lots, group homes, shelters—where the right dose at the right moment can literally prevent a hospitalization or a return to jail. We don’t treat on rigid schedules. We treat based on symptoms, insight, and risk.

We treat people—not package inserts.

And to do that well, we need partners who don’t just innovate in the lab but follow through in the community.

I hope Teva takes a hard look at this gap. Because Uzedy has clinical potential—but without access to the full dose range, and without timely support for providers, that potential goes unrealized. Worse, it becomes another story of missed opportunity in a system already full of them.

Meanwhile, I’ll continue using the new Maintena protocol where appropriate, grateful that at least one manufacturer was willing to take the necessary steps—from research, to approval, to accessibility. Because in ACT, we know something many systems still don’t:

The window is short. The stakes are high. And the right tool at the right time can change everything.

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