Best Practices for Aripiprazole Lauroxil Administration: From Formulation Development to Injection Technique.

Long-acting injectable (LAI) antipsychotics are an important treatment option for patients with schizophrenia. Advances and variability in formulation technology have provided several LAI antipsychotic treatment options for schizophrenia, with a wide range of doses and dose intervals. However, clinical reviews of LAIs have not focused on formulation development despite its clinical relevance to injection safety and technique. This article reviews the relationship between formulation technology and clinical practices for LAIs, with a focus on aripiprazole lauroxil, a long-acting atypical antipsychotic indicated for the treatment of schizophrenia. The formulation developed for aripiprazole lauroxil is an aqueous-based suspension suitable for use as a prefilled syringe that, after injection, will release aripiprazole slowly into the plasma. The clinical relationship between the aripiprazole lauroxil formulation and proper injection techniques is explained, including why tapping and shaking the syringe to resuspend the drug particles and rapid injection speed are key steps for best injection practices for this formulation.

Silicon addition to hydroxyapatite increases nanoscale electrostatic, van der Waals, and adhesive interactions.

The normal intersurface forces between nanosized probe tips functionalized with COO(-)-terminated alkanethiol self-assembling monolayers and dense, polycrystalline silicon-substituted synthetic hydroxyapatite (SiHA) and phase pure hydroxyapatite (HA) were measured via a nanomechanical technique called chemically specific high-resolution force spectroscopy. A significantly larger van der Waals interaction was observed for the SiHA compared to HA; Hamaker constants (A) were found to be A(SiHA) = 35 +/- 27 zJ and A(HA) = 13 +/- 12 zJ. Using the Derjaguin-Landau-Verwey-Overbeek approximation, which assumes linear additivity of the electrostatic double layer and van der Waals components, and the nonlinear Poisson-Boltzmann surface charge model for electrostatic double-layer forces, the surface charge per unit area, sigma (C/m(2)), was calculated as a function of position for specific nanosized areas within individual grains. SiHA was observed to be more negatively charged than HA with sigma(SiHA) = -0.024 +/- 0.013 C/m(2), two times greater than sigma(HA) = -0.011 +/- 0.006 C/m(2). Additionally, SiHA was found to have increased surface adhesion (0.7 +/- 0.3 nN) compared to HA (0.5 +/- 0.3 nN). The characterization of the nanoscale variations in surface forces of SiHA and HA will enable an improved understanding of the initial stages of bone-biomaterial bonding.

Nanoscale variation in surface charge of synthetic hydroxyapatite detected by chemically and spatially specific high-resolution force spectroscopy.

The normal intersurface forces between nanosized probe tips functionalized with COO-- and NH3+-terminated alkanethiol self-assembling monolayers and dense polycrystalline phase pure synthetic hydroxyapatite (HA) were measured via a powerful nanomechanical technique called chemically specific high-resolution force spectroscopy. The data taken on approach of the probe tip to the HA surface was compared to the nonlinear Poisson-Boltzmann-based electrostatic double layer theory to predict the surface charge per unit area of the HA, sigmaHA (C/m2), as a function of ionic strength, position within a variety of grains, and across grain boundaries. The average sigmaHA was found to be approximately -0.02 C/m2 and to vary from -0.0037 to -0.072 C/m2 with nanoscale position in relation to grain boundaries and crystal planes up to -0.19 C/m2/microm. Positional measurement of nanoscale surface properties holds great promise in elucidating the molecular origins of physicochemical processes occurring at the biomaterial interface.