Abilify Mycite
FDA Label NDC 59148-032

Increased Mortality in Elderly Patients with Dementia-Related Psychosis

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. ABILIFY MYCITE is not approved for the treatment of patients with dementia-related psychosis [see Warnings and Precautions (5.1)].

Suicidal Thoughts and Behaviors

Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors [see Warnings and Precautions (5.2)]. The safety and efficacy of ABILIFY MYCITE have not been established in pediatric patients [see Use in Specific Populations (8.4)].

Limitations of Use:

• The ability of the ABILIFY MYCITE to improve patient compliance or modify aripiprazole dosage has not been established [see Dosage and Administration (2.1)].
• The use of ABILIFY MYCITE to track drug ingestion in "real-time" or during an emergency is not recommended because detection may be delayed or not occur [see Dosage and Administration (2.1)].

ABILIFY MYCITE

Administer ABILIFY MYCITE orally with or without food [see Clinical Pharmacology (12.3)]. Swallow tablets with sensor whole; do not divide, crush, or chew.

MYCITE Patch

There are two types of MYCITE Patch (referred to as patch). Each type has a corresponding Instructions for Use (IFU) within the app [see How Supplied/Storage and Handling (16.1)]:

• For the 1-component patch, apply only when instructed by the app to the left side of the body just above the lower edge of the rib cage.
• For the 2-component patch, apply only when instructed by the app to the right or left side of the body just above the lower edge of the rib cage.

Additional patch instructions:

• Do not place the patch in areas where the skin is scraped, cracked, inflamed, or irritated, or in a location that overlaps the area of the most recently removed patch (if there is skin irritation, instruct patients to remove the patch).
• The app will prompt the patient to change the patch (at least weekly or sooner), and to apply and remove the patch correctly.
• Keep the patch on when showering, swimming, or exercising.
• For those undergoing an MRI, remove the patch and replace with a new patch as soon as possible.

Hyperglycemia/Diabetes Mellitus

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics. There have been reports of hyperglycemia in patients treated with aripiprazole [see Adverse Reactions (6.1, 6.2)]. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse events is not completely understood. However, epidemiological studies suggest an increased risk of hyperglycemia-related adverse reactions in patients treated with the atypical antipsychotics.

Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.

In an analysis of 13 placebo-controlled monotherapy trials in adults, primarily with schizophrenia or bipolar disorder, the mean change in fasting glucose in aripiprazole -treated patients (+4.4 mg/dL; median exposure 25 days; N=1057) was not significantly different than in placebo-treated patients (+2.5 mg/dL; median exposure 22 days; N=799). Table 4 shows the proportion of aripiprazole-treated patients with normal and borderline fasting glucose at baseline (median exposure 25 days) that had treatment-emergent high fasting glucose measurements compared to placebo-treated patients (median exposure 22 days).

Table 4: Changes in Fasting Glucose in Placebo-Controlled Monotherapy Trials in Adult Patients (Primarily Schizophrenia and Bipolar Disorder)

	Category Change (at least once) from Baseline	Treatment Arm	n/N	%
Fasting Glucose	Normal to High (<100 mg/dL to ≥126 mg/dL)	Aripiprazole	31/822	3.8
		Placebo	22/605	3.6
	Borderline to High (≥100 mg/dL and <126 mg/dL to ≥126 mg/dL)	Aripiprazole	31/176	17.6
		Placebo	13/142	9.2

At 24 weeks, the mean change in fasting glucose in aripiprazole-treated patients was not significantly different than in placebo-treated patients [+2.2 mg/dL (n=42) and +9.6 mg/dL (n=28), respectively].

The mean change in fasting glucose in adjunctive aripiprazole-treated patients with major depressive disorder (+0.7 mg/dL; median exposure 42 days; N=241) was not significantly different than in placebo-treated patients (+0.8 mg/dL; median exposure 42 days; N=246). Table 5 shows the proportion of adult patients with changes in fasting glucose levels from two placebo-controlled, adjunctive trials (median exposure 42 days) in patients with major depressive disorder.

Table 5: Changes in Fasting Glucose from Placebo-Controlled Adjunctive Trials in Adult Patients with Major Depressive Disorder

	Category Change (at least once) from Baseline	Treatment Arm	n/N	%
Fasting Glucose	Normal to High (<100 mg/dL to ≥126 mg/dL)	Aripiprazole	2/201	1.0
		Placebo	2/204	1.0
	Borderline to High (≥100 mg/dL and <126 mg/dL to ≥126 mg/dL)	Aripiprazole	4/34	11.8
		Placebo	3/37	8.1

Dyslipidemia

Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics.

Analyses of patients with at least 12 or 24 weeks of exposure were limited by small numbers of patients. Table 6 shows the proportion of adult patients, primarily from pooled schizophrenia and bipolar disorder monotherapy placebo-controlled trials, with changes in total cholesterol (pooled from 17 trials; median exposure 21 to 25 days), fasting triglycerides (pooled from eight trials; median exposure 42 days), fasting LDL cholesterol (pooled from eight trials; median exposure 39 to 45 days, except for placebo-treated patients with baseline normal fasting LDL measurements, who had median treatment exposure of 24 days) and HDL cholesterol (pooled from nine trials; median exposure 40 to 42 days).

Table 6: Changes in Blood Lipid Parameters from Placebo-Controlled Monotherapy Trials in Adults (Primarily Schizophrenia and Bipolar Disorder)

	Treatment Arm	n/N	%
Total Cholesterol Normal to High (<200 mg/dL to ≥240 mg/dL)	Aripiprazole	34/1357	2.5
	Placebo	27/973	2.8
Fasting Triglycerides Normal to High (<150 mg/dL to ≥200 mg/dL)	Aripiprazole	40/539	7.4
	Placebo	30/431	7.0
Fasting LDL Cholesterol Normal to High (<100 mg/dL to ≥160 mg/dL)	Aripiprazole	2/332	0.6
	Placebo	2/268	0.7
HDL Cholesterol Normal to Low (≥40 mg/dL to <40 mg/dL)	Aripiprazole	121/1066	11.4
	Placebo	99/794	12.5

In monotherapy trials in adults, the proportion of patients at 12 weeks and 24 weeks with changes from normal to high in total cholesterol (fasting/nonfasting), fasting triglycerides, and fasting LDL cholesterol were similar between aripiprazole- and placebo-treated patients: at 12 weeks, total cholesterol (fasting/nonfasting), 1/71 (1.4%) vs. 3/74 (4.1%); fasting triglycerides, 8/62 (12.9%) vs. 5/37 (13.5%); fasting LDL cholesterol, 0/34 (0%) vs. 1/25 (4.0%), respectively; and at 24 weeks, total cholesterol (fasting/nonfasting), 1/42 (2.4%) vs. 3/37 (8.1%); fasting triglycerides, 5/34 (14.7%) vs. 5/20 (25%); fasting LDL cholesterol, 0/22 (0%) vs. 1/18 (5.6%), respectively.

Table 7 shows the proportion of patients with changes in total cholesterol (fasting/nonfasting), fasting triglycerides, fasting LDL cholesterol, and HDL cholesterol from two placebo-controlled adjunctive trials in adult patients with major depressive disorder (median exposure 42 days).

Table 7: Changes in Blood Lipid Parameters from Placebo-Controlled Adjunctive Trials in Adult Patients with Major Depressive Disorder

	Treatment Arm	n/N	%
Total Cholesterol Normal to High (<200 mg/dL to ≥240 mg/dL)	Aripiprazole	3/139	2.2
	Placebo	7/135	5.2
Fasting Triglycerides Normal to High (<150 mg/dL to ≥200 mg/dL)	Aripiprazole	14/145	9.7
	Placebo	6/147	4.1
Fasting LDL Cholesterol Normal to High (<100 mg/dL to ≥160 mg/dL)	Aripiprazole	0/54	0
	Placebo	0/73	0
HDL Cholesterol Normal to Low (≥40 mg/dL to <40 mg/dL)	Aripiprazole	17/318	5.3
	Placebo	10/286	3.5

Weight Gain

Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.

In an analysis of 13 placebo-controlled monotherapy trials, primarily from pooled schizophrenia and bipolar disorder, with a median exposure of 21 to 25 days, the mean change in body weight in aripiprazole-treated patients was +0.3 kg (N=1673) compared to –0.1 kg (N=1100) in placebo-controlled patients. At 24 weeks, the mean change from baseline in body weight in aripiprazole-treated patients was –1.5 kg (n=73) compared to –0.2 kg (n=46) in placebo-treated patients.

In the trials adding aripiprazole to antidepressants, patients first received 8 weeks of antidepressant treatment followed by 6 weeks of adjunctive aripiprazole or placebo in addition to their ongoing antidepressant treatment. The mean change in body weight in patients receiving adjunctive aripiprazole was +1.7 kg (N=347) compared to +0.4 kg (N=330) in patients receiving adjunctive placebo.

Table 8 shows the percentage of adult patients with weight gain ≥7% of body weight by indication.

Table 8: Percentage of Patients From Placebo-Controlled Trials in Adult Patients with Weight Gain ≥7% of Body Weight 

Weight gain ≥7% of body weight	Indication	Treatment Arm	N	Patients n (%)
	Schizophrenia 4 to 6 weeks duration.	Aripiprazole	852	69 (8.1)
		Placebo	379	12 (3.2)
	Bipolar Mania 3 weeks duration.	Aripiprazole	719	16 (2.2)
		Placebo	598	16 (2.7)
	Major Depressive Disorder  (Adjunctive Therapy) 6 weeks duration.	Aripiprazole	347	18 (5.2)
		Placebo	330	2 (0.6)

Adverse Reactions in Adult Patients with Schizophrenia

The following findings are based on a pool of five placebo-controlled trials (four 4-week and one 6-week) in which oral aripiprazole was administered in doses ranging from 2 to 30 mg/day.

The commonly observed adverse reaction associated with the use of aripiprazole tablets in patients with schizophrenia (incidence of 5% or greater and aripiprazole tablets incidence at least twice that for placebo) was akathisia (aripiprazole tablets 8%; placebo 4%).

Adverse Reactions in Adult Patients with Bipolar Mania

Adult Patients Who Received Monotherapy

The following findings are based on a pool of 3-week, placebo-controlled bipolar mania trials in which oral aripiprazole was administered at doses of 15 or 30 mg/day.

Commonly observed adverse reactions associated with the use of aripiprazole tablets in patients with bipolar mania (incidence of 5% or greater and aripiprazole tablets incidence at least twice that for placebo) are shown in Table 9.

Table 9: Commonly Observed Adverse Reactions in Short-Term, Placebo-Controlled Trials of Adult Patients with Bipolar Mania Treated with Oral Aripiprazole Monotherapy

	Percentage of Patients Reporting Reaction
Preferred Term	Aripiprazole tablets (n=917)	Placebo (n=753)
Akathisia	13	4
Sedation	8	3
Restlessness	6	3
Tremor	6	3
Extrapyramidal Disorder	5	2

Table 10 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks in schizophrenia and up to 3 weeks in bipolar mania), including only those reactions that occurred in 2% or more of patients treated with aripiprazole tablets (doses ≥2 mg/day) and for which the incidence in patients treated with aripiprazole tablets was greater than the incidence in patients treated with placebo in the combined dataset.

Table 10: Adverse Reactions in Short-Term, Placebo-Controlled Trials in Adult Patients Treated with Oral Aripiprazole

	Percentage of Patients Reporting Reaction Adverse reactions reported by at least 2% of patients treated with oral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo
System Organ Class Preferred Term	Aripiprazole tablets (n=1843)	Placebo (n=1166)
Eye Disorders
Blurred Vision	3	1
Gastrointestinal Disorders
Nausea	15	11
Constipation	11	7
Vomiting	11	6
Dyspepsia	9	7
Dry Mouth	5	4
Toothache	4	3
Abdominal Discomfort	3	2
Stomach Discomfort	3	2
General Disorders and Administration Site Conditions
Fatigue	6	4
Pain	3	2
Musculoskeletal and Connective Tissue Disorders
Musculoskeletal Stiffness	4	3
Pain in Extremity	4	2
Myalgia	2	1
Muscle Spasms	2	1
Nervous System Disorders
Headache	27	23
Dizziness	10	7
Akathisia	10	4
Sedation	7	4
Extrapyramidal Disorder	5	3
Tremor	5	3
Somnolence	5	3
Psychiatric Disorders
Agitation	19	17
Insomnia	18	13
Anxiety	17	13
Restlessness	5	3
Respiratory, Thoracic, and Mediastinal Disorders
Pharyngolaryngeal Pain	3	2
Cough	3	2

An examination of population subgroups did not reveal any clear evidence of differential adverse reaction incidence on the basis of age, gender, or race.

Adult Patients with Adjunctive Therapy with Bipolar Mania

The following findings are based on a placebo-controlled trial of adult patients with bipolar disorder in which aripiprazole tablets was administered at doses of 15 or 30 mg/day as adjunctive therapy with lithium or valproate.

In a study of patients who were already tolerating either lithium or valproate as monotherapy, discontinuation rates due to adverse reactions were 12% for patients treated with adjunctive aripiprazole tablets compared to 6% for patients treated with adjunctive placebo. The most common adverse drug reactions associated with discontinuation in the adjunctive aripiprazole-treated compared to placebo-treated patients were akathisia (5% and 1%, respectively) and tremor (2% and 1%, respectively).

The commonly observed adverse reactions associated with adjunctive aripiprazole tablets and lithium or valproate in patients with bipolar mania (incidence of 5% or greater and incidence at least twice that for adjunctive placebo) were: akathisia, insomnia, and extrapyramidal disorder.

Table 11 enumerates the incidence, rounded to the nearest percent, of adverse reactions that occurred during acute treatment (up to 6 weeks), including only those reactions that occurred in 2% or more of patients treated with adjunctive aripiprazole tablets (doses of 15 or 30 mg/day) and lithium or valproate and for which the incidence in patients treated with this combination was greater than the incidence in patients treated with placebo plus lithium or valproate.

Table 11: Adverse Reactions in a Short-Term, Placebo-Controlled Trial of Adjunctive Therapy in Patients with Bipolar Disorder

	Percentage of Patients Reporting Reaction Adverse reactions reported by at least 2% of patients treated with oral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo
System Organ Class Preferred Term	Aripiprazole tablets + Li or Val Lithium or Valproate (n=253)	Placebo + Li or Val (n=130)
Gastrointestinal Disorders
Nausea	8	5
Vomiting	4	0
Salivary Hypersecretion	4	2
Dry Mouth	2	1
Infections and Infestations
Nasopharyngitis	3	2
Investigations
Weight Increased	2	1
Nervous System Disorders
Akathisia	19	5
Tremor	9	6
Extrapyramidal Disorder	5	1
Dizziness	4	1
Sedation	4	2
Psychiatric Disorders
Insomnia	8	4
Anxiety	4	1
Restlessness	2	1

Adult Patients Receiving Aripiprazole Tablets as Adjunctive Treatment of Major Depressive Disorder

The following findings are based on a pool of two placebo-controlled trials of patients with major depressive disorder in which aripiprazole tablets were administered at doses of 2 mg to 20 mg as adjunctive treatment to continued antidepressant therapy.

The incidence of discontinuation due to adverse reactions was 6% for adjunctive aripiprazole-treated patients and 2% for adjunctive placebo-treated patients.

The commonly observed adverse reactions associated with the use of adjunctive aripiprazole tablets in patients with major depressive disorder (incidence of 5% or greater and aripiprazole tablets incidence at least twice that for placebo) were: akathisia, restlessness, insomnia, constipation, fatigue, and blurred vision.

Table 12 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks), including only those adverse reactions that occurred in 2% or more of patients treated with adjunctive aripiprazole tablets (doses ≥2 mg/day) and for which the incidence in patients treated with adjunctive aripiprazole tablets was greater than the incidence in patients treated with adjunctive placebo in the combined dataset.

Table 12: Adverse Reactions in Short-Term, Placebo-Controlled Adjunctive Trials in Patients with Major Depressive Disorder

	Percentage of Patients Reporting Reaction Adverse reactions reported by at least 2% of patients treated with adjunctive aripiprazole tablets, except adverse reactions which had an incidence equal to or less than placebo
System Organ Class Preferred Term	Aripiprazole tablets + ADT Antidepressant Therapy (n=371)	Placebo + ADT (n=366)
Eye Disorders
Blurred Vision	6	1
Gastrointestinal Disorders
Constipation	5	2
General Disorders and Administration Site Conditions
Fatigue	8	4
Feeling Jittery	3	1
Infections and Infestations
Upper Respiratory Tract Infection	6	4
Investigations
Weight Increased	3	2
Metabolism and Nutrition Disorders
Increased Appetite	3	2
Musculoskeletal and Connective Tissue Disorders
Arthralgia	4	3
Myalgia	3	1
Nervous System Disorders
Akathisia	25	4
Somnolence	6	4
Tremor	5	4
Sedation	4	2
Dizziness	4	2
Disturbance in Attention	3	1
Extrapyramidal Disorder	2	0
Psychiatric Disorders
Restlessness	12	2
Insomnia	8	2

Dose-Related Adverse Reactions in Patients with Schizophrenia

Dose response relationships for the incidence of treatment-emergent adverse events were evaluated from four trials in adult patients with schizophrenia comparing various fixed doses (2, 5, 10, 15, 20, and 30 mg/day) of oral aripiprazole to placebo. This analysis, stratified by study, indicated that the only adverse reaction to have a possible dose response relationship, and then most prominent only with 30 mg, was somnolence [including sedation]; (incidences were placebo, 7.1%; 10 mg, 8.5%; 15 mg, 8.7%; 20 mg, 7.5%; 30 mg, 12.6%).

Extrapyramidal Symptoms

Schizophrenia

In short-term, placebo-controlled trials in schizophrenia in adults, the incidence of reported EPS-related events, excluding events related to akathisia, for aripiprazole-treated patients was 13% vs. 12% for placebo; and the incidence of akathisia-related events for aripiprazole-treated patients was 8% vs. 4% for placebo.

Objectively collected data from those trials was collected on the Simpson Angus Rating Scale (for EPS), the Barnes Akathisia Scale (for akathisia), and the Assessments of Involuntary Movement Scales (for dyskinesias). In the adult schizophrenia trials, the objectively collected data did not show a difference between aripiprazole tablets and placebo, with the exception of the Barnes Akathisia Scale (aripiprazole tablets, 0.08; placebo, –0.05).

Similarly, in a long-term (26-week), placebo-controlled trial of schizophrenia in adults, objectively collected data on the Simpson Angus Rating Scale (for EPS), the Barnes Akathisia Scale (for akathisia), and the Assessments of Involuntary Movement Scales (for dyskinesias) did not show a difference between aripiprazole tablets and placebo.

Bipolar Mania

In the short-term, placebo-controlled trials in bipolar mania in adults, the incidence of reported EPS-related events, excluding events related to akathisia, for monotherapy aripiprazole-treated patients was 16% vs. 8% for placebo and the incidence of akathisia-related events for monotherapy aripiprazole-treated patients was 13% vs. 4% for placebo. In the 6-week placebo-controlled trial in bipolar mania for adjunctive therapy with lithium or valproate, the incidence of reported EPS-related events, excluding events related to akathisia for adjunctive aripiprazole-treated patients was 15% vs. 8% for adjunctive placebo and the incidence of akathisia-related events for adjunctive aripiprazole-treated patients was 19% vs. 5% for adjunctive placebo.

In the adult bipolar mania trials with monotherapy aripiprazole tablets, the Simpson Angus Rating Scale and the Barnes Akathisia Scale showed a significant difference between aripiprazole tablets and placebo (aripiprazole tablets, 0.50; placebo, –0.01 and aripiprazole tablets, 0.21; placebo, –0.05). Changes in the Assessments of Involuntary Movement Scales were similar for the aripiprazole tablets and placebo groups. In the bipolar mania trials with aripiprazole tablets as adjunctive therapy with either lithium or valproate, the Simpson Angus Rating Scale and the Barnes Akathisia Scale showed a significant difference between adjunctive aripiprazole tablets and adjunctive placebo (aripiprazole tablets, 0.73; placebo, 0.07 and aripiprazole tablets, 0.30; placebo, 0.11). Changes in the Assessments of Involuntary Movement Scales were similar for adjunctive aripiprazole tablets and adjunctive placebo.

Major Depressive Disorder

In the short-term, placebo-controlled trials in major depressive disorder, the incidence of reported EPS-related events, excluding events related to akathisia, for adjunctive aripiprazole-treated patients was 8% vs. 5% for adjunctive placebo-treated patients; and the incidence of akathisia-related events for adjunctive aripiprazole-treated patients was 25% vs. 4% for adjunctive placebo-treated patients.

In the major depressive disorder trials, the Simpson Angus Rating Scale and the Barnes Akathisia Scale showed a significant difference between adjunctive aripiprazole tablets and adjunctive placebo (aripiprazole tablets, 0.31; placebo, 0.03 and aripiprazole tablets, 0.22; placebo, 0.02). Changes in the Assessments of Involuntary Movement Scales were similar for the adjunctive aripiprazole tablets and adjunctive placebo groups.

Dystonia

Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.

Skin Irritation for MYCITE Patch

Symptoms of skin irritation localized at the site of the MYCITE Patch may occur in some patients. In clinical studies with the 1-component patch, sixty-one patients (12.4%) experienced skin rashes localized at the site of patch placement.

Adverse Reactions in Long-Term, Double-Blind, Placebo-Controlled Trials

The adverse reactions reported in a 26-week, double-blind trial comparing oral aripiprazole and placebo in patients with schizophrenia were generally consistent with those reported in the short-term, placebo-controlled trials, except for a higher incidence of tremor [8% (12/153) for aripiprazole tablets vs. 2% (3/153) for placebo]. In this study, the majority of the cases of tremor were of mild intensity (8/12 mild and 4/12 moderate), occurred early in therapy (9/12 ≤49 days), and were of limited duration (7/12 ≤10 days). Tremor led to discontinuation (<1%) of aripiprazole tablets. In addition, in a long-term (52 weeks), active-controlled study, the incidence of tremor was 5% (40/859) for aripiprazole tablets. A similar profile was observed in a long-term monotherapy study and a long-term adjunctive study with lithium and valproate in bipolar disorder.

Other Adverse Reactions Observed during the Premarketing Evaluation of Aripiprazole

Other adverse reactions associated with aripiprazole are presented below. The listing does not include reactions: 1) already listed in previous tables or elsewhere in labeling, 2) for which a drug cause was remote, 3) which were so general as to be uninformative, 4) which were not considered to have significant clinical implications, or 5) which occurred at a rate equal to or less than placebo.

Reactions are categorized by body system according to the following definitions: frequent adverse reactions are those occurring in at least 1/100 patients; infrequent adverse reactions are those occurring in 1/100 to 1/1000 patients; rare reactions are those occurring in fewer than 1/1000 patients:

• Blood and Lymphatic System Disorders: rare - thrombocytopenia
• Cardiac Disorders: infrequent – bradycardia, palpitations, rare – atrial flutter, cardio-respiratory arrest, atrioventricular block, atrial fibrillation, angina pectoris, myocardial ischemia, myocardial infarction, cardiopulmonary failure
• Eye Disorders: infrequent – photophobia; rare - diplopia
• Gastrointestinal Disorders: infrequent - gastroesophageal reflux disease
• General Disorders and Administration Site Conditions: frequent - asthenia; infrequent – peripheral edema, chest pain; rare – face edema
• Hepatobiliary Disorders: rare - hepatitis, jaundice
• Immune System Disorders: rare- hypersensitivity
• Injury, Poisoning, and Procedural Complications: infrequent – fall; rare – heatstroke
• Investigations: frequent - weight decreased; infrequent - hepatic enzyme increased, blood glucose increased, blood lactate dehydrogenase increased, gamma glutamyl transferase increased; rare – blood prolactin increased, blood urea increased, blood creatinine increased, blood bilirubin increased, electrocardiogram QT prolonged, glycosylated hemoglobin increased
• Metabolism and Nutrition Disorders: frequent – anorexia; rare - hypokalemia, hyponatremia, hypoglycemia
• Musculoskeletal and Connective Tissue Disorders: infrequent - muscular weakness, muscle tightness; rare – rhabdomyolysis, mobility decreased
• Nervous System Disorders: infrequent - parkinsonism, memory impairment, cogwheel rigidity, hypokinesia, bradykinesia; rare – akinesia, myoclonus, coordination abnormal, speech disorder, grand mal convulsion; <1/10,000 patients - choreoathetosis
• Psychiatric Disorders: infrequent – aggression, loss of libido, delirium; rare – libido increased, anorgasmia, tic, homicidal ideation, catatonia, sleep walking
• Renal and Urinary Disorders: rare - urinary retention, nocturia
• Reproductive System and Breast Disorders: infrequent - erectile dysfunction; rare – gynaecomastia, menstruation irregular, amenorrhea, breast pain, priapism
• Respiratory, Thoracic, and Mediastinal Disorders: infrequent - nasal congestion, dyspnea
• Skin and Subcutaneous Tissue Disorders: infrequent - rash, hyperhidrosis, pruritus, photosensitivity reaction, alopecia; rare - urticaria
• Vascular Disorders: infrequent – hypotension, hypertension

Pregnancy Exposure Registry

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ABILIFY MYCITE during pregnancy. For more information contact the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or visit http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/.

Risk Summary

Neonates exposed to antipsychotic drugs, including ABILIFY MYCITE, during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms [see Clinical Considerations]. There are no available data on aripiprazole use in pregnant women to inform a drug-associated risk of major birth defects and miscarriage. Animal reproduction studies were conducted with aripiprazole in rats and rabbits during organogenesis, and in rats during the pre-and post-natal period. Oral and intravenous aripiprazole administration during organogenesis in rats and/or rabbits at doses higher than the maximum recommended human dose (MRHD) produced fetal death, decreased fetal weight, undescended testicles, delayed skeletal ossification, skeletal abnormalities, and diaphragmatic hernia. Oral and intravenous aripiprazole administration during the pre- and post-natal period in rats at doses higher than the MRHD produced prolonged gestation, stillbirths, decreased pup weight, and decreased pup survival. Consider the benefits and risks of ABILIFY MYCITE and possible risks to the fetus when prescribing ABILIFY MYCITE to a pregnant woman. Advise pregnant women of potential fetal risk.

The background risk of major birth defects and miscarriage for the indicated population are unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.

Clinical Considerations

Fetal/Neonatal Adverse Reactions

Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder have been reported in neonates who were exposed to antipsychotic drugs (including aripiprazole) during the third trimester of pregnancy. These symptoms have varied in severity. Some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization. Monitor neonates for extrapyramidal and/or withdrawal symptoms.

Data

Animal Data

In animal studies, aripiprazole demonstrated developmental toxicity, including possible teratogenic effects in rats and rabbits.

Pregnant rats were treated with oral doses of 3, 10, and 30 mg/kg/day (1, 3, and 10 times the MRHD on mg/m² basis) of aripiprazole during the period of organogenesis. Gestation was slightly prolonged at 30 mg/kg/day. Treatment at the high dose of 30 mg/kg/day caused a slight delay in fetal development (decreased fetal weight), undescended testes, and delayed skeletal ossification (also seen at 10 mg/kg/day). There were no adverse effects on embryofetal or pup survival. Delivered offspring had decreased body weights (10 and 30 mg/kg/day) and increased incidences of hepatodiaphragmatic nodules and diaphragmatic hernia at 30 mg/kg (the other dose groups were not examined for these findings). Postnatally, delayed vaginal opening was seen at 10 and 30 mg/kg/day and impaired reproductive performance (decreased fertility rate, corpora lutea, implants, live fetuses, and increased post-implantation loss, likely mediated through effects on female offspring) was seen at 30 mg/kg/day. Some maternal toxicity was seen at 30 mg/kg/day however, there was no evidence to suggest that these developmental effects were secondary to maternal toxicity.

In pregnant rats receiving aripiprazole injection intravenously (3, 9, and 27 mg/kg/day) during the period of organogenesis, decreased fetal weight and delayed skeletal ossification were seen at the highest dose where it also caused maternal toxicity.

Pregnant rabbits were treated with oral doses of 10, 30, and 100 mg/kg/day (2 , 3, and 11 times human exposure at MRHD based on AUC and 6, 19, and 65 times the MRHD based on mg/m²) of aripiprazole during the period of organogenesis. At the high dose of 100 mg/kg/day decreased maternal food consumption, and increased abortions were seen as well as increased fetal mortality, decreased fetal weight (also seen at 30 mg/kg/day), increased incidence of a skeletal abnormality (fused sternebrae) (also seen at 30 mg/kg/day).

In pregnant rabbits receiving aripiprazole injection intravenously (3, 10, and 30 mg/kg/day) during the period of organogenesis, the highest dose, which caused pronounced maternal toxicity, resulted in decreased fetal weight, increased fetal abnormalities (primarily skeletal), and decreased fetal skeletal ossification. The fetal no-effect dose was 10 mg/kg/day, which is 5 times the human exposure at the MRHD based on AUC and is 6 times the MRHD based on mg/m².

In a study in which rats were treated peri- and post-natally with oral doses of 3, 10, and 30 mg/kg/day (1, 3, and 10 times the MRHD on mg/m² basis) of aripiprazole from gestation Day 17 through Day 21 postpartum, slight maternal toxicity, slightly prolonged gestation an increase in stillbirths and decreases in pup weight (persisting into adulthood) and survival were seen at 30 mg/kg/day.

In rats receiving aripiprazole injection intravenously (3, 8, and 20 mg/kg/day) from gestation Day 6 through Day 20 postpartum, an increase in stillbirths was seen at 8 and 20 mg/kg/day, and decreases in early postnatal pup weights and survival were seen at 20 mg/kg/day; these effects were seen in presence of maternal toxicity. There were no effects on postnatal behavioral and reproductive development.

The effect of ABILIFY MYCITE on labor and delivery in humans is unknown.

Risk Summary

Aripiprazole is present in human breast milk; however, there are insufficient data to assess the amount in human milk, the effects on the breastfed infant, or the effects on milk production.

The development and health benefits of breastfeeding should be considered along with the mother's clinical need for ABILIFY MYCITE and any potential adverse effects on the breastfed infant from ABILIFY MYCITE or from the underlying maternal condition.

Charcoal: In the event of an overdose of ABILIFY MYCITE, an early charcoal administration may be useful in partially preventing the absorption of aripiprazole. Administration of 50 g of activated charcoal, one hour after a single 15 mg oral dose of aripiprazole, decreased the mean AUC and C_max of aripiprazole by 50%.

Hemodialysis: Although there is no information on the effect of hemodialysis in treating an overdose with aripiprazole, hemodialysis is unlikely to be useful in overdose management since aripiprazole is highly bound to plasma proteins.

Absorption

Aripiprazole is well absorbed after administration of the tablet, with peak plasma concentrations occurring within 3 hours to 5 hours; the absolute oral bioavailability of the tablet formulation is 87%. ABILIFY MYCITE can be administered with or without food. Administration of a 15 mg aripiprazole tablet with a standard high-fat meal did not significantly affect the C_max or AUC of aripiprazole or its active metabolite, dehydro-aripiprazole, but delayed T_max by 3 hours for aripiprazole and 12 hours for dehydro-aripiprazole.

Distribution

The steady-state volume of distribution of aripiprazole following intravenous administration is high (404 L or 4.9 L/kg), indicating extensive extravascular distribution. At therapeutic concentrations, aripiprazole and its major metabolite are greater than 99% bound to serum proteins, primarily to albumin. In healthy human volunteers administered 0.5 to 30 mg/day aripiprazole for 14 days, there was dose-dependent D₂ receptor occupancy indicating brain penetration of aripiprazole in humans.

Elimination

Metabolism

Aripiprazole is metabolized primarily by three biotransformation pathways: dehydrogenation, hydroxylation, and N-dealkylation. Based on in vitro studies, CYP3A4 and CYP2D6 enzymes are responsible for dehydrogenation and hydroxylation of aripiprazole, and N-dealkylation is catalyzed by CYP3A4. Aripiprazole is the predominant drug moiety in the systemic circulation. At steady-state, dehydro-aripiprazole, the active metabolite, represents about 40% of aripiprazole AUC in plasma.

Excretion

Following a single oral dose of [¹⁴C]-labeled aripiprazole, approximately 25% and 55% of the administered radioactivity was recovered in the urine and feces, respectively. Less than 1% of unchanged aripiprazole was excreted in the urine and approximately 18% of the oral dose was recovered unchanged in the feces.

Drug Interaction Studies

Effects of other drugs on the exposures of aripiprazole and dehydro-aripiprazole are summarized in Figure 1 and Figure 2, respectively. Based on simulation, a 4.5-fold increase in mean C_max and AUC values at steady-state is expected when extensive metabolizers of CYP2D6 are administered with both strong CYP2D6 and CYP3A4 inhibitors. A 3-fold increase in mean C_max and AUC values at steady-state is expected in poor metabolizers of CYP2D6 administered with strong CYP3A4 inhibitors.

Figure 1: The Effects of Other Drugs on Aripiprazole Pharmacokinetics



Figure 1 (Mycite Figure 01)

Figure 2: The Effects of Other Drugs on Dehydro-aripiprazole Pharmacokinetics



Figure 2 (Mycite Figure 02)

The effects of aripiprazole on the exposures of other drugs are summarized in Figure 3. A population PK analysis in patients with major depressive disorder showed no substantial change in plasma concentrations of fluoxetine (20 or 40 mg/day), paroxetine CR (37.5 or 50 mg/day), or sertraline (100 or 150 mg/day) dosed to steady-state. The steady-state plasma concentrations of fluoxetine and norfluoxetine increased by about 18% and 36%, respectively, and concentrations of paroxetine decreased by about 27%. The steady-state plasma concentrations of sertraline and desmethylsertraline were not substantially changed when these antidepressant therapies were coadministered with aripiprazole.

Figure 3: The Effects of Aripiprazole on Pharmacokinetics of Other Drugs



Figure 3 (Mycite Figure 03)

Specific Populations

Exposures of aripiprazole and dehydro-aripiprazole in specific populations are summarized in Figure 4 and Figure 5, respectively.

Figure 4: Effects of Intrinsic Factors on Aripiprazole Pharmacokinetics



Figure 4 (Mycite Figure 04)

Figure 5: Effects of Intrinsic Factors on Dehydro-aripiprazole Pharmacokinetics



Figure 5 (Mycite Figure 05)

Carcinogenesis

Lifetime carcinogenicity studies were conducted in ICR mice, Sprague-Dawley (SD) rats, and F344 rats. Aripiprazole was administered for 2 years in the diet at doses of 1, 3, 10, and 30 mg/kg/day to ICR mice and 1, 3, and 10 mg/kg/day to F344 rats (0.2 to 5 times and 0.3 to 3 times the maximum recommended human dose [MRHD] based on mg/m², respectively). In addition, SD rats were dosed orally for 2 years at 10, 20, 40, and 60 mg/kg/day (3 to 19 times the MRHD based on mg/m²). Aripiprazole did not induce tumors in male mice or male rats. In female mice, the incidences of pituitary gland adenomas and mammary gland adenocarcinomas and adenoacanthomas were increased at dietary doses of 3 to 30 mg/kg/day (0.1 to 0.9 times human exposure at MRHD based on AUC and 0.5 to 5 times the MRHD based on mg/m²). In female rats, the incidence of mammary gland fibroadenomas was increased at a dietary dose of 10 mg/kg/day (0.1 times human exposure at MRHD based on AUC and 3 times the MRHD based on mg/m²); and the incidences of adrenocortical carcinomas and combined adrenocortical adenomas/carcinomas were increased at an oral dose of 60 mg/kg/day (14 times human exposure at MRHD based on AUC and 19 times the MRHD based on mg/m²).

Proliferative changes in the pituitary and mammary gland of rodents have been observed following chronic administration of other antipsychotic agents and are considered prolactin-mediated. Serum prolactin was not measured in the aripiprazole carcinogenicity studies. However, increases in serum prolactin levels were observed in female mice in a 13-week dietary study at the doses associated with mammary gland and pituitary tumors. Serum prolactin was not increased in female rats in 4-week and 13-week dietary studies at the dose associated with mammary gland tumors. The relevance for human risk of the findings of prolactin-mediated endocrine tumors in rodents is unknown.

Mutagenesis

The mutagenic potential of aripiprazole was tested in the in vitro bacterial reverse-mutation assay, the in vitro bacterial DNA repair assay, the in vitro forward gene mutation assay in mouse lymphoma cells, the in vitro chromosomal aberration assay in Chinese hamster lung (CHL) cells, the in vivo micronucleus assay in mice, and the unscheduled DNA synthesis assay in rats. Aripiprazole and a metabolite (2,3-DCPP) were clastogenic in the in vitro chromosomal aberration assay in CHL cells with and without metabolic activation. The metabolite, 2,3-DCPP, produced increases in numerical aberrations in the in vitro assay in CHL cells in the absence of metabolic activation. A positive response was obtained in the in vivo micronucleus assay in mice; however, the response was due to a mechanism not considered relevant to humans.

Impairment of Fertility

Female rats were treated with oral doses of 2, 6, and 20 mg/kg/day (0.6, 2, and 6 times the MRHD on a mg/m² basis) of aripiprazole from 2 weeks prior to mating through Day 7 of gestation. Estrus cycle irregularities and increased corpora lutea were seen at all doses, but no impairment of fertility was seen. Increased pre-implantation loss was seen at 6 and 20 mg/kg/day and decreased fetal weight was seen at 20 mg/kg/day.

Male rats were treated with oral doses of 20, 40, and 60 mg/kg/day (6, 13, and 19 times the MRHD on a mg/m² basis) of aripiprazole from 9 weeks prior to mating through mating. Disturbances in spermatogenesis were seen at 60 mg/kg and prostate atrophy was seen at 40 and 60 mg/kg, but no impairment of fertility was seen.

Acute Treatment of Manic and Mixed Episodes

Monotherapy

The efficacy of aripiprazole tablets as monotherapy in the acute treatment of manic and mixed episodes associated with bipolar I disorder was established in four 3-week placebo-controlled trials in hospitalized patients who met the DSM-IV criteria for bipolar I disorder with manic or mixed episodes. These studies included patients with or without psychotic features and two of the studies also included patients with or without a rapid-cycling course.

The primary instrument used for assessing manic symptoms was the Young Mania Rating Scale (Y-MRS), an 11-item clinician-rated scale traditionally used to assess the degree of manic symptomatology in a range from 0 (no manic features) to 60 (maximum score). A key secondary instrument included the Clinical Global Impression-Bipolar (CGI-BP) Scale.

In the four positive, 3-week placebo-controlled trials (n=268; n=248; n=480; n=485) which evaluated aripiprazole tablets in a range of 15 mg to 30 mg, once daily (with a starting dose of 30 mg/day in two studies and 15 mg/day in two studies), aripiprazole tablets were superior to placebo in the reduction of Y-MRS total score (Studies 1 to 4 in Table 15) and CGI-BP Severity of Illness score (mania). In the two studies with a starting dose of 15 mg/day, 48% and 44% of patients were on 15 mg/day at endpoint. In the two studies with a starting dose of 30 mg/day, 86% and 85% of patients were on 30 mg/day at endpoint.

Adjunctive Therapy

The efficacy of adjunctive aripiprazole tablets with concomitant lithium or valproate in the treatment of manic or mixed episodes associated with Bipolar I Disorder was established in a 6-week placebo-controlled study (n=384) with a 2-week lead-in mood stabilizer monotherapy phase in adult patients who met DSM-IV criteria for bipolar I disorder. This study included patients with manic or mixed episodes and with or without psychotic features.

Patients were initiated on open-label lithium (0.6 to 1.0 mEq/L) or valproate (50 to 125 μg/mL) at therapeutic serum levels and remained on stable doses for 2 weeks. At the end of 2 weeks, patients demonstrating inadequate response (Y-MRS total score ≥16 and ≤25% improvement on the Y-MRS total score) to lithium or valproate were randomized to receive either aripiprazole tablets (15 mg/day or an increase to 30 mg/day as early as Day 7) or placebo as adjunctive therapy with open-label lithium or valproate. In the 6-week placebo-controlled phase, adjunctive aripiprazole tablets starting at 15 mg/day with concomitant lithium or valproate (in a therapeutic range of 0.6 to 1.0 mEq/L or 50 to 125 μg/mL, respectively) was superior to lithium or valproate with adjunctive placebo in the reduction of the Y-MRS total score (Study 5 in Table 15) and CGI-BP Severity of Illness score (mania). Seventy-one percent of the patients coadministered valproate and 62% of the patients coadministered lithium were on 15 mg/day at 6-week endpoint.

Table 15: Bipolar Studies

Study Number	Treatment Group	Primary Efficacy Measure: Y-MRS
		Mean Baseline Score (SD)	LS Mean Change from Baseline (SE)	Placebo-subtracted Difference Difference (drug minus placebo) in least-squares mean change from baseline. (95% CI)
SD: standard deviation; SE: standard error; LS Mean: least-squares mean; CI: unadjusted confidence interval.
Study 1	Aripiprazole tablets (30/15 mg/day) Doses statistically significantly superior to placebo.	29.0 (5.9)	-12.52 (1.05)	-5.33 (-7.90, -2.76)
	Placebo	28.5 (4.6)	-7.19 (1.07)	--
Study 2	Aripiprazole tablets (30/15  mg/day)	27.8 (5.7)	-8.15 (1.23)	-4.80 (-7.80, -1.80)
	Placebo	29.1 (6.9)	-3.35(1.22)	--
Study 3	Aripiprazole tablets (15 to 30 mg/day)	28.5 (5.6)	-12.64 (0.84)	-3.63 (-5.75 , -1.51)
	Placebo	28.9 (5.9)	9.01 (0.81)	--
Study 4	Aripiprazole tablets (15 to 30 mg/day)	28.0 (5.8)	-11.98 (0.80)	-2.28 (-4.44 , -0.11)
	Placebo	28.3 (5.8)	-9.70 (0.83)	--
Study 5	Aripiprazole tablets (15 or 30 mg/day) + Lithium/Valproate	23.2 (5.7)	-13.31 (0.50)	-2.62 (-4.29 , -0.95)
	Placebo + Lithium/Valproate	23.0 (4.9)	-10.70 (0.69)	--

Maintenance Treatment of Bipolar I Disorder

Monotherapy Maintenance Therapy

A maintenance trial was conducted in adult patients meeting DSM-IV criteria for bipolar I disorder with a recent manic or mixed episode who had been stabilized on open-label aripiprazole tablets and who had maintained a clinical response for at least 6 weeks. The first phase of this trial was an open-label stabilization period in which inpatients and outpatients were clinically stabilized and then maintained on open-label aripiprazole tablets (15 or 30 mg/day, with a starting dose of 30 mg/day) for at least 6 consecutive weeks. One hundred sixty-one outpatients were then randomized in a double-blind fashion to either the same dose of aripiprazole tablets they were on at the end of the stabilization and maintenance period or placebo and were then monitored for manic or depressive relapse. During the randomization phase, aripiprazole tablets were superior to placebo on time to the number of combined affective relapses (manic plus depressive), the primary outcome measure for this study (Study 7 in Figure 7). A total of 55 mood events were observed during the double-blind treatment phase. Nineteen were from the aripiprazole tablets group and 36 were from the placebo group. The number of observed manic episodes in the aripiprazole tablets group (6) were fewer than that in the placebo group (19), while the number of depressive episodes in the aripiprazole tablets group (9) was similar to that in the placebo group (11).

An examination of population subgroups did not reveal any clear evidence of differential responsiveness on the basis of age and gender; however, there were insufficient numbers of patients in each of the ethnic groups to adequately assess inter-group differences.

Figure 7: Kaplan-Meier Estimation of Cumulative Proportion of Patients with Relapse (Bipolar Study 7)



Figure 7 (Mycite Figure 07)

Adjunctive Maintenance Therapy

An adjunctive maintenance trial was conducted in adult patients meeting DSM-IV criteria for bipolar I disorder with a recent manic or mixed episode. Patients were initiated on open-label lithium (0.6 to 1.0 mEq/L) or valproate (50 to 125 μg/mL) at therapeutic serum levels, and remained on stable doses for 2 weeks. At the end of 2 weeks, patients demonstrating inadequate response (Y-MRS total score ≥16 and ≤35% improvement on the Y-MRS total score) to lithium or valproate received aripiprazole tablets with a starting dose of 15 mg/day with the option to increase to 30 mg or reduce to 10 mg as early as Day 4, as adjunctive therapy with open-label lithium or valproate. Prior to randomization, patients on the combination of single-blind aripiprazole tablets and lithium or valproate were required to maintain stability (Y-MRS and MADRS total scores ≤12) for 12 consecutive weeks. Three hundred thirty-seven patients were then randomized in a double-blind fashion, to either the same dose of aripiprazole tablets they were on at the end of the stabilization period or placebo plus lithium or valproate and were then monitored for manic, mixed, or depressive relapse for a maximum of 52 weeks. Aripiprazole tablets were superior to placebo on the primary endpoint, time from randomization to relapse to any mood event (Study 8 in Figure 8). A mood event was defined as hospitalization for a manic, mixed, or depressive episode, study discontinuation due to lack of efficacy accompanied by Y-MRS score >16 and/or a MADRS >16, or an SAE of worsening disease accompanied by Y-MRS score >16 and/or a MADRS >16. A total of 68 mood events were observed during the double-blind treatment phase. Twenty-five were from the aripiprazole group and 43 were from the placebo group. The number of observed manic episodes in the aripiprazole group (7) were fewer than that in the placebo group (19), while the number of depressive episodes in the aripiprazole group (14) was similar to that in the placebo group (18). The Kaplan-Meier curves of the time from randomization to relapse to any mood event during the 52-week double-blind treatment phase for aripiprazole tablets and placebo groups are shown in Figure 8.

An examination of population subgroups did not reveal any clear evidence of differential responsiveness on the basis of age and gender; however, there were insufficient numbers of patients in each of the ethnic groups to adequately assess inter-group differences.

Figure 8: Kaplan-Meier Estimation of Cumulative Proportion of Patients with Relapse to Any Mood Event (Bipolar Study 8)



Figure 8 (Mycite Figure 08)

Tablet bottle:

Store 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].

Do not store in conditions where tablets are exposed to humid conditions.

MYCITE Patch (Wearable Sensor):

Store between 5°C and 27°C (41°F to 81°F), 15% to 93% relative humidity.

General Instructions for Use

Instruct patients to:

• Refer to the app store to ensure compatibility with their specific smartphone.
• First download the MYCITE App and follow instructions provided by the app.

Advise patients that:

• The initial use should be facilitated by the healthcare provider [see Dosage and Administration (2.1)].
• They need a functioning pod before using the Maintenance Kit [see How Supplied/Storage and Handling (16.1)].

Advise patients that most ingestions will be detected within 30 minutes; however, in some cases it can take over two hours for the smartphone app and web portal to detect the ingestion of ABILIFY MYCITE. In some cases, the ingestion of the tablet may not be detected. If the tablet is not detected after ingestion, the dose should not be repeated.

Managing Lost or Disabled Smartphone

Advise patients that if their smartphone is lost, impaired or otherwise rendered unusable, some information collected by the system (synced) may be lost. Advise patients to change their MYCITE Patch immediately and connect to a new smartphone using their current account information. Information previously synced to the patients account will be available.

Using the MYCITE Patch in Different Environments

The MYCITE Patch will communicate with a paired device when it is within 9-foot proximity. The MYCITE Patch should remain on an individual whether they are showering, swimming, or exercising as it is intended to tolerate water or perspiration. Patients undergoing an MRI, however, need to remove their patch and replace with a new one as soon as possible. In order for the MYCITE Patch to communicate with a smartphone, the device must be powered on and Bluetooth^®-enabled.

Suicidal Thoughts and Behaviors

Advise patients and caregivers to look for the emergence of suicidality, especially early during treatment and when the dosage is adjusted up or down and instruct them to report such symptoms to the healthcare provider [see Boxed Warning, Warnings and Precautions (5.2)].

Neuroleptic Malignant Syndrome (NMS)

Counsel patients about a potentially fatal adverse reaction referred to as Neuroleptic Malignant Syndrome (NMS) that has been reported in association with administration of antipsychotic drugs. Advise patients to contact a healthcare provider or report to the emergency room if they experience signs or symptoms of NMS [see Warnings and Precautions (5.4)].

Tardive Dyskinesia

Advise patients that abnormal involuntary movements have been associated with the administration of antipsychotic drugs. Counsel patients on the signs and symptoms of tardive dyskinesia and to contact their healthcare provider if these abnormal movements occur [see Warnings and Precautions (5.5)].

Metabolic Changes

Educate patients about the risk of metabolic changes, how to recognize symptoms of hyperglycemia and diabetes mellitus, and the need for specific monitoring, including blood glucose, lipids, and weight [see Warnings and Precautions (5.6)].

Pathological Gambling and Other Compulsive Behaviors

Advise patients and their caregivers of the possibility that they may experience compulsive urges to shop, increased urges to gamble, compulsive sexual urges, binge eating and/or other compulsive urges and the inability to control these urges while taking aripiprazole. In some cases, but not all, the urges were reported to have stopped when the dose was reduced or stopped [see Warnings and Precautions (5.7)].

Orthostatic Hypotension and Syncope

Educate patients about the risk of orthostatic hypotension and syncope especially early in treatment, when re-initiating treatment, or when increasing the dosage [see Warnings and Precautions (5.8)].

Leukopenia, Neutropenia and Agranulocytosis

Advise patients with a pre-existing low WBC or a history of drug induced leukopenia/neutropenia that they should have their CBC monitored while taking ABILIFY MYCITE [see Warnings and Precautions (5.10)].

Interference with Cognitive and Motor Performance

Because ABILIFY MYCITE may have the potential to impair judgment, thinking, or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that ABILIFY MYCITE therapy does not affect them adversely [see Warnings and Precautions (5.12)].

Heat Exposure and Dehydration

Counsel patients regarding appropriate care in avoiding overheating and dehydration [see Warnings and Precautions (5.13)].

Concomitant Medication

Patients should be advised to inform their physicians if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions [see Drug Interactions (7)].

Pregnancy

Advise patients that ABILIFY MYCITE may cause extrapyramidal and/or withdrawal symptoms in a neonate and to notify their healthcare provider with a known or suspected pregnancy. Advise patients that there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ABILIFY MYCITE during pregnancy [see Use In Specific Populations (8.1)].

Tablets with embedded IEM sensors Manufactured by Otsuka Pharmaceutical Co., Ltd., Tokyo, 101-8535 Japan

MYCITE Patches Manufactured for Otsuka America Pharmaceutical, Inc. 3956 Point Eden Way, Hayward, CA 94545 USA

Distributed and marketed by Otsuka America Pharmaceutical, Inc., Rockville, MD 20850 USA

ABILIFY MYCITE^® and MYCITE^® are registered trademarks of Otsuka Pharmaceutical Co., Ltd.

©2020, Otsuka Pharmaceutical Co., Ltd., Tokyo, 101-8535 Japan

ABILIFY MYCITE, a drug-device combination product comprised of aripiprazole tablets embedded with an Ingestible Event Marker (IEM) sensor intended to track drug ingestion, is indicated for the:

• Treatment of adults with schizophrenia.
• Treatment of bipolar I disorder
  • Acute treatment of adults with manic and mixed episodes as monotherapy and as adjunct to lithium or valproate.
  • Maintenance treatment of adults as monotherapy and as adjunct to lithium or valproate.
  • Adjunctive treatment of adults with Major Depressive Disorder.

The ABILIFY MYCITE System is composed of the following:

• Aripiprazole tablet embedded with an IEM sensor (ABILIFY MYCITE);
• MYCITE^® Patch (wearable sensor) that detects the signal from the IEM sensor after ingestion and transmits data to a smartphone (referred to as the patch);
• MYCITE App - a smartphone application which is used with a compatible smartphone to display information for the patient (referred to as the app);
• Web-based portal for healthcare professionals and caregivers

Prior to initial patient use of the ABILIFY MYCITE System, facilitate use of ABILIFY MYCITE and the patch, app, and portal; ensure the patient is capable and willing to use a smartphone and the app; and instruct patients to [see How Supplied/Storage and Handling (16.1)]:

• Download the app,
• Follow all the instructions in the Instructions for Use within the app and the Quick Start Guide within the carton, and
• Ensure that the app is compatible with their specific smartphone and is paired with the patch prior to use.

Prior to prescribing the ABILIFY MYCITE Maintenance Kit ensure the patient has access to the appropriate components of the patch [see How Supplied/Storage and Handling (16.1)].

Although most ingestions will be detected within 30 minutes, it may take up to two hours for the app and portal to detect the ingestion of ABILIFY MYCITE; in some cases, the ingestion of the tablet with sensor may not be detected. If the tablet with sensor is not detected after ingestion, do not repeat the dose [see Adverse Reactions (6)].

The recommended starting and target dosage for ABILIFY MYCITE in adults with schizophrenia is 10 or 15 mg daily. Dosage increases should generally not be made before 2 weeks [see Clinical Pharmacology (12.3)]. The maximum recommended dosage is 30 mg daily; however, doses above 15 mg daily have shown no additional clinically meaningful benefit.

The recommended starting dosage in adults with acute and mixed episodes associated with bipolar I disorder is 15 mg given once daily as monotherapy and 10 mg to 15 mg given once daily as adjunctive treatment with lithium or valproate. The recommended target dose of ABILIFY MYCITE is 15 mg daily, as monotherapy or as adjunctive treatment with lithium or valproate. The dosage may be increased to 30 mg daily based on clinical response. The maximum recommended daily dosage is 30 mg.

The recommended starting dose for ABILIFY MYCITE as adjunctive treatment of adults with MDD taking an antidepressant is 2 to 5 mg daily. The recommended dosage range is 2 to 15 mg daily. Dosage adjustments of up to 5 mg daily should occur gradually, at intervals of no less than 1 week. The maximum recommended daily dosage is 15 mg. Periodically reassess to determine the continued need for maintenance treatment.

Dosage adjustments are recommended in patients who are known CYP2D6 poor metabolizers and in patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers (see Table 1). When the coadministered drug is withdrawn from the combination therapy, ABILIFY MYCITE dosage should then be adjusted to its original level. When the coadministered CYP3A4 inducer is withdrawn, ABILIFY MYCITE dosage should be reduced to the original level over 1 to 2 weeks. Patients who may be receiving a combination of strong, moderate, and weak inhibitors of CYP3A4 and CYP2D6 (e.g., a strong CYP3A4 inhibitor and a moderate CYP2D6 inhibitor or a moderate CYP3A4 inhibitor with a moderate CYP2D6 inhibitor), the dosing may be reduced to one-quarter (25%) of the usual dose initially and then adjusted based on clinical response.

When adjunctive ABILIFY MYCITE is administered to patients with major depressive disorder, ABILIFY MYCITE should be administered without dosage adjustment as specified in [Dosage and Administration (2.5)].

ABILIFY MYCITE (aripiprazole tablets with sensor) is available as described in Table 2.

ABILIFY MYCITE is contraindicated in patients with a history of a hypersensitivity reaction to aripiprazole. Reactions have ranged from pruritus/urticaria to anaphylaxis [see Adverse Reactions (6.2)].

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group.

Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. ABILIFY MYCITE is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning, and Warnings and Precautions (5.3)].

In pooled analyses of placebo-controlled trials of antidepressant drugs (SSRIs and other antidepressant classes) that included approximately 77,000 adult patients and over 4,400 pediatric patients, the incidence of suicidal thoughts and behaviors in pediatric and young adult patients was greater in antidepressant-treated patients than in placebo-treated patients. The safety and efficacy of ABILIFY MYCITE have not been established in pediatric patients [see Use in Specific Populations (8.4)]. The drug-placebo differences in the number of cases of suicidal thoughts and behaviors per 1000 patients treated are provided in Table 3.

No suicides occurred in any of the pediatric studies. There were suicides in the adult studies, but the number was not sufficient to reach any conclusion about antidepressant drug effect on suicide.

It is unknown whether the risk of suicidal thoughts and behaviors in pediatric and young adult patients extends to longer-term use, i.e., beyond four months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with MDD that antidepressants delay the recurrence of depression.

Monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors, especially during the initial few months of drug therapy and at times of dosage changes. Counsel family members or caregivers of patients to monitor for changes in behavior and to alert the healthcare provider. Consider changing the therapeutic regimen, including possibly discontinuing ABILIFY MYCITE, in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

In placebo-controlled clinical studies (two flexible-dose and one fixed-dose study) of dementia-related psychosis, there was an increased incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in aripiprazole-treated patients (mean age: 84 years; range: 78 to 88 years). In the fixed-dose study, there was a statistically significant dose-response relationship for cerebrovascular adverse events in patients treated with aripiprazole. ABILIFY MYCITE is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning].

A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) may occur with administration of antipsychotic drugs, including ABILIFY MYCITE. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure.

The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to exclude cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat-stroke, drug fever, and primary central nervous system pathology.

The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.

If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported.

A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs, including ABILIFY MYCITE. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown.

The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses.

The syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome and, thereby, may possibly mask the underlying process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.

Given these considerations, ABILIFY MYCITE should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that (1) is known to respond to antipsychotic drugs and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically.

If signs and symptoms of tardive dyskinesia appear in a patient on ABILIFY MYCITE, drug discontinuation should be considered. However, some patients may require treatment with ABILIFY MYCITE despite the presence of the syndrome.

Atypical antipsychotic drugs have caused metabolic changes that include hyperglycemia, diabetes mellitus, dyslipidemia, and body weight gain. While all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own specific risk profile.

Postmarketing case reports suggest that patients can experience intense urges, particularly for gambling, and the inability to control these urges while taking aripiprazole. Other compulsive urges, reported less frequently, include: sexual urges, shopping, eating or binge eating, and other impulsive or compulsive behaviors. Because patients may not recognize these behaviors as abnormal, it is important for prescribers to ask patients or their caregivers specifically about the development of new or intense gambling urges, compulsive sexual urges, compulsive shopping, binge or compulsive eating, or other urges while being treated with ABILIFY MYCITE. It should be noted that impulse-control symptoms can be associated with the underlying disorder. In some cases, although not all, urges were reported to have stopped when the dose was reduced or the medication was discontinued. Compulsive behaviors may result in harm to the patient and others if not recognized. Consider dose reduction or stopping the medication if a patient develops such urges.

ABILIFY MYCITE may cause orthostatic hypotension, perhaps due to its α₁-adrenergic receptor antagonism. The incidence of orthostatic hypotension-associated events from short-term, placebo-controlled trials of adult patients on oral aripiprazole (n=2467) included (aripiprazole incidence, placebo incidence) orthostatic hypotension (1%, 0.3%), postural dizziness (0.5%, 0.3%), and syncope (0.5%, 0.4%) [see Adverse Reactions (6.1)].

The incidence of a significant orthostatic change in blood pressure (defined as a decrease in systolic blood pressure ≥20 mmHg accompanied by an increase in heart rate ≥25 bpm when comparing standing to supine values) for aripiprazole was not meaningfully different from placebo (aripiprazole incidence, placebo incidence) in adult oral aripiprazole-treated patients (4%, 2%).

ABILIFY MYCITE should be used with caution in patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure or conduction abnormalities), cerebrovascular disease, or conditions which would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications) [see Drug Interactions (7.1)].

Antipsychotics, including ABILIFY MYCITE, may cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy.

In clinical trials and/or postmarketing experience, events of leukopenia and neutropenia have been reported temporally related to antipsychotic agents, including aripiprazole. Agranulocytosis has also been reported.

Possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC)/absolute neutrophil count (ANC) and history of drug-induced leukopenia/neutropenia. In patients with a history of a clinically significant low WBC/ANC or drug-induced leukopenia/neutropenia, perform a complete blood count (CBC) frequently during the first few months of therapy. In such patients, consider discontinuation of ABILIFY MYCITE at the first sign of a clinically significant decline in WBC in the absence of other causative factors.

Monitor patients with clinically significant neutropenia for fever or other symptoms or signs of infection and treat promptly if such symptoms or signs occur. Discontinue ABILIFY MYCITE in patients with severe neutropenia (absolute neutrophil count <1000/mm³) and follow their WBC counts until recovery.

In short-term, placebo-controlled trials, patients with a history of seizures excluded seizures/convulsions occurred in 0.1% (3/2467) of undiagnosed adult patients treated with oral aripiprazole.

As with other antipsychotic drugs, ABILIFY MYCITE should be used cautiously in patients with a history of seizures or with conditions that lower the seizure threshold. Conditions that lower the seizure threshold may be more prevalent in a population of 65 years or older.

ABILIFY MYCITE, like other antipsychotics, has the potential to impair judgment, thinking, or motor skills. In short-term, placebo-controlled trials, somnolence (including sedation) was reported in 11% of aripiprazole-treated patients compared with 6% of placebo-treated patients. Somnolence (including sedation) led to discontinuation in 0.3% (8/2467) of adult patients on oral aripiprazole in short-term, placebo-controlled trials.

Patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that therapy with ABILIFY MYCITE does not affect them adversely.

Disruption of the body's ability to reduce core body temperature has been attributed to antipsychotic agents. Appropriate care is advised when prescribing ABILIFY MYCITE for patients who will be experiencing conditions which may contribute to an elevation in core body temperature (e.g., exercising strenuously, exposure to extreme heat, receiving concomitant medication with anticholinergic activity, or being subject to dehydration).

Esophageal dysmotility and aspiration have been associated with antipsychotic drug use, including aripiprazole. ABILIFY MYCITE and other antipsychotic drugs should be used cautiously in patients at risk for aspiration pneumonia.

The following adverse reactions are discussed in more detail in other sections of the labeling:

• Increased Mortality in Elderly Patients with Dementia-Related Psychosis [see Boxed Warning and Warnings and Precautions (5.1)]
• Suicidal Thoughts and Behaviors in Pediatric and Young Adult Patients [see Boxed Warning and Warnings and Precautions (5.2)]
• Cerebrovascular Adverse Events, Including Stroke [see Warnings and Precautions (5.3)]
• Neuroleptic Malignant Syndrome (NMS) [see Warnings and Precautions (5.4)]
• Tardive Dyskinesia [see Warnings and Precautions (5.5)]
• Metabolic Changes [see Warnings and Precautions (5.6)]
• Pathological Gambling and Other Compulsive Behaviors [see Warnings and Precautions (5.7)]
• Orthostatic Hypotension [see Warnings and Precautions (5.8)]
• Falls [see Warnings and Precautions (5.9)]
• Leukopenia, Neutropenia, and Agranulocytosis [see Warnings and Precautions (5.10)]
• Seizures [see Warnings and Precautions (5.11)]
• Potential for Cognitive and Motor Impairment [see Warnings and Precautions (5.12)]
• Body Temperature Regulation [see Warnings and Precautions (5.13)]
• Dysphagia [see Warnings and Precautions (5.14)]

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The safety of ABILIFY MYCITE for the treatment of adults with schizophrenia, treatment of adults with manic and mixed episodes associated with bipolar I disorder, and adjunctive treatment of adults with major depressive disorder (MDD) has been established and is based on trials of aripiprazole including 13,543 adult patients who participated in multiple-dose clinical trials in schizophrenia, bipolar disorder, major depressive disorder, and other disorders, and who had approximately 7619 patient-years of exposure to oral aripiprazole. A total of 3390 patients were treated with oral aripiprazole for at least 180 days and 1933 patients treated with oral aripiprazole had at least 1 year of exposure.

The conditions and duration of treatment with aripiprazole (monotherapy and adjunctive therapy with antidepressants or mood stabilizers) included (in overlapping categories) double-blind, comparative and noncomparative open-label studies, inpatient and outpatient studies, fixed- and flexible-dose studies, and short- and longer-term exposure.

The most common adverse reactions of aripiprazole in adult patients in clinical trials (≥10%) were nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, insomnia, and restlessness.

The following adverse reactions have been identified during post-approval use of aripiprazole. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: occurrences of allergic reaction (anaphylactic reaction, angioedema, laryngospasm, pruritus/urticaria, or oropharyngeal spasm), pathological gambling, hiccups, blood glucose fluctuation, oculogyric crisis and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

Table 13 below includes clinically important drug interactions with ABILIFY MYCITE.

Based on pharmacokinetic studies, no dosage adjustment of ABILIFY MYCITE is required when administered concomitantly with famotidine, valproate, lithium, lorazepam.

In addition, no dosage adjustment is necessary for substrates of CYP2D6 (e.g., dextromethorphan, fluoxetine, paroxetine, or venlafaxine), CYP2C9 (e.g., warfarin), CYP2C19 (e.g., omeprazole, warfarin, escitalopram), or CYP3A4 (e.g., dextromethorphan) when co-administered with ABILIFY MYCITE. Additionally, no dosage adjustment is necessary for valproate, lithium, lamotrigine, lorazepam, or sertraline when co-administered with ABILIFY MYCITE [see Clinical Pharmacology (12.3)].

Safety and effectiveness of ABILIFY MYCITE in pediatric patients have not been established.

Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric patients [see Boxed Warning,and Warnings and Precautions (5.2)].

No dosage adjustment of ABILIFY MYCITE is recommended for elderly patients for the approved indications [see Boxed Warning, Warnings and Precautions (5.1) and Clinical Pharmacology (12.3)].

Of the 13,543 patients treated with oral aripiprazole in clinical trials, 1073 (8%) were ≥65 years old and 799 (6%) were ≥75 years old. Placebo-controlled studies of oral aripiprazole in schizophrenia, bipolar mania, or major depressive disorder did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Elderly patients treated with antipsychotic drugs with dementia-related psychosis had a greater incidence of stroke and transient ischemic attack. ABILIFY MYCITE is not approved for the treatment of elderly patients with dementia-related psychosis [see Boxed Warning and Warnings and Precautions (5.1, 5.3)].

ABILIFY MYCITE dosage adjustment is recommended in known CYP2D6 poor metabolizers due to high aripiprazole concentrations. Approximately 8% of Caucasians and 3 to 8% of Black/African Americans cannot metabolize CYP2D6 substrates and are classified as poor metabolizers (PM) [see Dosage and Administration (2.6) and Clinical Pharmacology (12.3)].

No dosage adjustment for ABILIFY MYCITE is required on the basis of a patient's hepatic function (mild to severe hepatic impairment, Child-Pugh score between 5 and 15) or renal function (mild to severe renal impairment, glomerular filtration rate between 15 and 90 mL/minute) [see Clinical Pharmacology (12.3)].

No dosage adjustment for ABILIFY MYCITE is required on the basis of a patient's sex, race, or smoking status [see Clinical Pharmacology (12.3)].

ABILIFY MYCITE is not a controlled substance.

ABILIFY MYCITE has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence. Consequently, patients should be evaluated carefully for a history of drug abuse, and such patients should be observed closely for signs of ABILIFY MYCITE misuse or abuse (e.g., development of tolerance, increases in dose, drug-seeking behavior).

In physical dependence studies in monkeys, withdrawal symptoms were observed upon abrupt cessation of dosing. While the clinical trials did not reveal any tendency for any drug-seeking behavior, these observations were not systematic and it is not possible to predict on the basis of this limited experience the extent to which a CNS-active drug will be misused, diverted, and/or abused once marketed.

In clinical trials and in postmarketing experience, adverse reactions of deliberate or accidental overdosage with oral aripiprazole have been reported worldwide. These include overdoses with oral aripiprazole alone and in combination with other substances.

Common adverse reactions (reported in at least 5% of all overdose cases) reported with oral aripiprazole overdosage (alone or in combination with other substances) include vomiting, somnolence, and tremor. Other clinically important signs and symptoms observed in one or more patients with aripiprazole overdoses (alone or with other substances) include acidosis, aggression, aspartate aminotransferase increased, atrial fibrillation, bradycardia, coma, confusional state, convulsion, blood creatine phosphokinase increased, depressed level of consciousness, hypertension, hypokalemia, hypotension, lethargy, loss of consciousness, QRS complex prolonged, QT prolonged, pneumonia aspiration, respiratory arrest, status epilepticus, and tachycardia.

No specific information is available on the treatment of overdose with ABILIFY MYCITE. If over-exposure occurs call your poison control center at 1-800-222-1222. An electrocardiogram should be obtained in case of overdosage and if QT interval prolongation is present, cardiac monitoring should be instituted. Otherwise, management of overdose should concentrate on supportive therapy, maintaining an adequate airway, oxygenation and ventilation, and management of symptoms. Close medical supervision and monitoring should continue until the patient recovers.

ABILIFY MYCITE (aripiprazole tablets with sensor) is a drug-device combination product containing aripiprazole, an atypical antipsychotic, embedded with an Ingestible Event Marker (IEM) sensor.

Aripiprazole is 7-[4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxy]-3,4-dihydrocarbostyril. The empirical formula is C₂₃H₂₇Cl₂N₃O₂ and its molecular weight is 448.38. The chemical structure is:

Chemical Structure (Mycite Chem Structure)

ABILIFY MYCITE is available in 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg strength tablets with sensor. Inactive ingredients of the tablets with sensor include cornstarch, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate, and microcrystalline cellulose. Colorants include ferric oxide (yellow or red) and FD&C Blue No. 2 Aluminum Lake. Ingredients of the IEM include aluminum, cuprous chloride, ethyl cellulose, gold, hydroxypropyl cellulose, magnesium, silicon, silicon dioxide, silicon nitride, titanium-tungsten, titanium and triethyl citrate.

The ABILIFY MYCITE System is a drug-device combination product composed of the following components:

• An aripiprazole tablet with an embedded Ingestible Event Marker (IEM) sensor. The IEM is a 1 mm sized sensor embedded in the ABILIFY MYCITE tablets with sensor. Upon contact with gastric fluid, magnesium and cuprous chloride within the IEM react to activate and power the device. The IEM then communicates to the MYCITE Patch, to track aripiprazole ingestion.
• A MYCITE Patch (wearable sensor) is designed to detect the ingestion of the ABILIFY MYCITE tablets with sensor, record the ingestion of the IEM, and transmit ingestion data to the mobile patient application (app).
• A compatible app displays this data to allow patients to review their medication ingestion. These data can be shared with healthcare providers and caregivers.
• Web-based portal or dashboard for healthcare professionals and caregivers.

The mechanism of action of aripiprazole in the treatment of schizophrenia, bipolar I disorder, or adjunctive treatment of major depressive disorder is unknown. However, the efficacy of aripiprazole could be mediated through a combination of partial agonist activity at D₂ and 5-HT_1A receptors and antagonist activity at 5-HT_2A receptors.

Aripiprazole exhibits high affinity for dopamine D₂ and D₃, serotonin 5-HT_1A and 5-HT_2A receptors (K_i values of 0.34 nM, 0.8 nM, 1.7 nM, and 3.4 nM, respectively), moderate affinity for dopamine D₄, serotonin 5-HT_2C and 5-HT₇, alpha1-adrenergic and histamine H₁ receptors (K_i values of 44 nM, 15 nM, 39 nM, 57 nM, and 61 nM, respectively), and moderate affinity for the serotonin reuptake site (K_i=98 nM). Aripiprazole has no appreciable affinity for cholinergic muscarinic receptors (IC₅₀>1000 nM). Actions at receptors other than D₂, 5-HT_1A, and 5-HT_2A may explain some of the adverse reactions of aripiprazole (e.g., the orthostatic hypotension observed with aripiprazole may be explained by its antagonist activity at adrenergic alpha1 receptors).

Aripiprazole activity is presumably primarily due to the parent drug, aripiprazole, and to a lesser extent, to its major metabolite, dehydro-aripiprazole, which has been shown to have affinities for D₂ receptors similar to the parent drug and represents 40% of the parent drug exposure in plasma. The mean elimination half-lives are about 75 hours and 94 hours for aripiprazole and dehydro-aripiprazole, respectively. Steady-state concentrations are attained within 14 days of dosing for both active moieties. Aripiprazole accumulation is predictable from single-dose pharmacokinetics. At steady-state, the pharmacokinetics of aripiprazole is dose-proportional. Elimination of aripiprazole is mainly through hepatic metabolism involving two P450 isozymes, CYP2D6 and CYP3A4. For CYP2D6 poor metabolizers, the mean elimination half-life for aripiprazole is about 146 hours.

Aripiprazole produced retinal degeneration in albino rats in a 26-week chronic toxicity study at a dose of 60 mg/kg and in a 2-year carcinogenicity study at doses of 40 and 60 mg/kg. The 40 and 60 mg/kg/day doses are 13 and 19 times the maximum recommended human dose (MRHD) based on mg/m² and 7 to 14 times human exposure at MRHD based on AUC. Evaluation of the retinas of albino mice and of monkeys did not reveal evidence of retinal degeneration. Additional studies to further evaluate the mechanism have not been performed. The relevance of this finding to human risk is unknown.

The safety and efficacy of aripiprazole tablets for the treatment of adults with schizophrenia, acute treatment of adults with manic and mixed episodes associated with Bipolar I disorder, and adjunctive treatment of adults with major depressive disorder (MDD) has been established and is based on the following adequate and well-controlled trials of aripiprazole tablets:

• Four short-term trials and one maintenance trial in adult patients with schizophrenia [see Clinical Studies (14.2)]
• Four short-term monotherapy trials and one 6-week adjunctive trial in adult patients with manic or mixed episodes [see Clinical Studies (14.3)]
• One maintenance monotherapy trial and in one maintenance adjunctive trial in adult patients with bipolar I disorder [see Clinical Studies (14.3)]
• Two short-term trials in adult patients with MDD who had an inadequate response to antidepressant therapy during the current episode [see Clinical Studies (14.4)]

The efficacy of aripiprazole tablets in the treatment of schizophrenia was evaluated in five short-term (4-week and 6-week), placebo-controlled trials of acutely relapsed inpatients who predominantly met DSM-III/IV criteria for schizophrenia. Four of the five trials were able to distinguish aripiprazole tablets from placebo, but one study, the smallest, did not. Three of these studies also included an active control group consisting of either risperidone (one trial) or haloperidol (two trials), but they were not designed to allow for a comparison of aripiprazole tablets and the active comparators.

In the four positive trials for aripiprazole tablets, four primary measures were used for assessing psychiatric signs and symptoms. Efficacy was evaluated using the total score on the Positive and Negative Syndrome Scale (PANSS). The PANSS is a 30-item scale that measures positive symptoms of schizophrenia (7 items), negative symptoms of schizophrenia (7 items), and general psychopathology (16 items), each rated on a scale of 1 (absent) to 7 (extreme); total PANSS scores range from 30 to 210. The Clinical Global Impression (CGI) assessment reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, about the overall clinical state of the patient.

In a 4-week trial (n=414) comparing two fixed doses of aripiprazole tablets (15 or 30 mg/day) to placebo, both doses of aripiprazole tablets were superior to placebo in the PANSS total score (Study 1 in Table 14), PANSS positive subscale, and CGI-severity score. In addition, the 15 mg dose was superior to placebo in the PANSS negative subscale.

In a 4-week trial (n=404) comparing two fixed doses of aripiprazole tablets (20 or 30 mg/day) to placebo, both doses of aripiprazole tablets were superior to placebo in the PANSS total score (Study 2 in Table 14), PANSS positive subscale, PANSS negative subscale, and CGI-severity score.

In a 6-week trial (n=420) comparing three fixed doses of aripiprazole tablets (10, 15, or 20 mg/day) to placebo, all three doses of aripiprazole tablets were superior to placebo in the PANSS total score (Study 3 in Table 14), PANSS positive subscale, and the PANSS negative subscale.

In a 6-week trial (n=367) comparing three fixed doses of aripiprazole tablets (2, 5, or 10 mg/day) to placebo, the 10 mg dose of aripiprazole tablets was superior to placebo in the PANSS total score (Study 4 in Table 14), the primary outcome measure of the study. The 2 and 5 mg doses did not demonstrate superiority to placebo on the primary outcome measure.

Thus, the efficacy of 10, 15, 20, and 30 mg daily doses was established in two studies for each dose. Among these doses, there was no evidence that the higher dose groups offered any advantage over the lowest dose group of these studies.

An examination of population subgroups did not reveal any clear evidence of differential responsiveness on the basis of age, gender, or race.

A longer-term trial enrolled 310 inpatients or outpatients meeting DSM-IV criteria for schizophrenia who were, by history, symptomatically stable on other antipsychotic medications for periods of 3 months or longer. These patients were discontinued from their antipsychotic medications and randomized to aripiprazole tablets 15 mg/day or placebo for up to 26 weeks of observation for relapse. Relapse during the double-blind phase was defined as CGI-Improvement score of ≥5 (minimally worse), scores ≥5 (moderately severe) on the hostility or uncooperativeness items of the PANSS, or ≥20% increase in the PANSS total score. Patients receiving aripiprazole tablets 15 mg/day experienced a significantly longer time to relapse over the subsequent 26 weeks compared to those receiving placebo (Study 5 in Figure 6).

Figure 6: Kaplan-Meier Estimation of Cumulative Proportion of Patients with Relapse (Schizophrenia Study 5)

Figure 6 (Mycite Figure 06)

The efficacy of aripiprazole tablets in the adjunctive treatment of major depressive disorder (MDD) was demonstrated in two short-term (6-week), placebo-controlled trials of adult patients meeting DSM-IV criteria for MDD who had had an inadequate response to prior antidepressant therapy (1 to 3 courses) in the current episode and who had also demonstrated an inadequate response to 8 weeks of prospective antidepressant therapy (paroxetine extended-release, venlafaxine extended-release, fluoxetine, escitalopram, or sertraline). Inadequate response for prospective treatment was defined as less than 50% improvement on the 17-item version of the Hamilton Depression Rating Scale (HAMD17), minimal HAMD17 score of 14, and a Clinical Global Impressions Improvement rating of no better than minimal improvement. Inadequate response to prior treatment was defined as less than 50% improvement as perceived by the patient after a minimum of 6 weeks of antidepressant therapy at or above the minimal effective dose.

The primary instrument used for assessing depressive symptoms was the Montgomery-Asberg Depression Rating Scale (MADRS), a 10-item clinician-rated scale used to assess the degree of depressive symptomatology. The key secondary instrument was the Sheehan Disability Scale (SDS), a 3-item self-rated instrument used to assess the impact of depression on three domains of functioning with each item scored from 0 (not at all) to 10 (extreme).

In the two trials (n=381, n=362), aripiprazole tablets were superior to placebo in reducing mean MADRS total scores (Studies 1, 2 in Table 16). In one study, aripiprazole tablets were also superior to placebo in reducing the mean SDS score.

In both trials, patients received aripiprazole tablets adjunctive to antidepressants at a dose of 5 mg/day. Based on tolerability and efficacy, doses could be adjusted by 5 mg increments, one week apart. Allowable doses were: 2, 5, 10, 15 mg/day, and for patients who were not on potent CYP2D6 inhibitors fluoxetine and paroxetine, 20 mg/day. The mean final dose at the end point for the two trials was 10.7 and 11.4 mg/day.

An examination of population subgroups did not reveal evidence of differential response based on age, choice of prospective antidepressant, or race. With regards to gender, a smaller mean reduction on the MADRS total score was seen in males than in females.

The ABILIFY MYCITE kit contains aripiprazole tablets embedded with an Ingestible Event Marker (IEM) sensor co-packaged with MYCITE Patches (wearable sensors) (referred to as the patch). The patch is available as either a:

• 1-component patch (see Table 17 and Figure 9). The 1-component kit contains (a) aripiprazole tablets with sensor and (b) patches (patches in this kit contain electronic components to record drug ingestion information and transfer the data to a compatible smartphone).
• 2-component patch comprised of a removable electronics module (referred to as the "pod") and an adhesive "strip" (see Table 18 and Figure 10). The pod contains electronic components to record drug ingestion information and transfer the data to a compatible smartphone. The 30 Day Starter kits contain (a) aripiprazole tablets with sensor, (b) strips, and (c) one pod; whereas, the Maintenance kits contain (a) aripiprazole tablets with sensor and (b) strips [see Dosage and Administration (2.2)].

Each patch has a corresponding IFU within the app. The status of the patch is indicated by a status icon in the app to inform the user that the patch is properly adhered and fully functioning.

Figure 9: MYCITE Patch (1-component)



Figure 9 (Mycite Figure 09)

Figure 10: MYCITE Patch (2-component)

Figure 10 (Mycite Figure 10)

Assembled      Figure 10 (Mycite Figure 11)

Table 17: ABILIFY MYCITE Kits (1-component patch)

Strength	Color/ Shape	Markings	Pack Size and Components (1-component patch)	NDC Code
2 mg	pale green modified rectangle	"DA-029" and "2"	Bottle of 30 tablets with sensor +7 MYCITE Patches	59148-029-85
5 mg	pale blue modified rectangle	"DA-030" and "5"	Bottle of 30 tablets with sensor +7 MYCITE Patches	59148-030-85
10 mg	off-white to pale pink modified rectangle	"DA-031" and "10"	Bottle of 30 tablets with sensor +7 MYCITE Patches	59148-031-85
15 mg	pale yellow round	"DA-032" and "15"	Bottle of 30 tablets with sensor +7 MYCITE Patches	59148-032-85
20 mg	white to pale yellowish white round	"DA-033" and "20"	Bottle of 30 tablets with sensor +7 MYCITE Patches	59148-033-85
30 mg	off-white to pale pink round	"DA-034" and "30"	Bottle of 30 tablets with sensor +7 MYCITE Patches	59148-034-85

Table 18: ABILIFY MYCITE Kits (2-component patch)

Strength	Color/ Shape	Markings	Pack Size and Components (2-component patch) The 2-component maintenance kits do not include the pod.	NDC Code
2 mg	pale green modified rectangle	"DA-029" and "2"	30 Day Starter kit: Bottle of 30 tablets with sensor +1 MYCITE pod and 7 MYCITE strips	59148-029-61
			Maintenance kit: Bottle of 30 tablets with sensor +7 MYCITE strips	59148-029-72
5 mg	pale blue modified rectangle	"DA-030" and "5"	30 Day Starter kit: Bottle of 30 tablets with sensor +1 MYCITE pod and 7 MYCITE strips	59148-030-61
			Maintenance kit: Bottle of 30 tablets with sensor +7 MYCITE strips	59148-030-72
10 mg	off-white to pale pink modified rectangle	"DA-031" and "10"	30 Day Starter kit: Bottle of 30 tablets with sensor +1 MYCITE pod and 7 MYCITE strips	59148-031-61
			Maintenance kit: Bottle of 30 tablets with sensor +7 MYCITE strips	59148-031-72
15 mg	pale yellow round	"DA-032" and "15"	30 Day Starter kit: Bottle of 30 tablets with sensor +1 MYCITE pod and 7 MYCITE strips	59148-032-61
			Maintenance kit: Bottle of 30 tablets with sensor +7 MYCITE strips	59148-032-72
20 mg	white to pale yellowish white round	"DA-033" and "20"	30 Day Starter kit: Bottle of 30 tablets with sensor +1 MYCITE pod and 7 MYCITE strips	59148-033-61
			Maintenance kit: Bottle of 30 tablets with sensor +7 MYCITE strips	59148-033-72
30 mg	off-white to pale pink round	"DA-034" and "30"	30 Day Starter kit: Bottle of 30 tablets with sensor +1 MYCITE pod and 7 MYCITE strips	59148-034-61
			Maintenance kit: Bottle of 30 tablets with sensor +7 MYCITE strips	59148-034-72

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

01_GETTING_STARTED

Image (Mycite Figure 12) ANIMATION: MyCite logo fades in, followed by section title.	Image (Mycite Figure 13) ANIMATION: Three containers expand with a generic phone w/ MyCite app, a patch, and a MyCite bottle. Patch and pod are separated slightly in space.	Image (Mycite Figure 14) ANIMATION: Containers fade out, the three items rearrange from a column to a circle. Patch and pod come together before moving.	Image (Mycite Figure 15) ANIMATION: A line draws from the bottle to the patch, leaving a dotted line behind.
VO:	VO: The MyCite system works in three connected parts: the MyCite App, a two-part patch consisting of a pod and adhesive strip, and an Abilify tablet with an ingestible sensor.	VO:	VO: The Abilify MyCite Tablet sends a signal to the Patch when you swallow your medication. The Patch records when you've taken your medication, as well as your rest and activity levels.

Image (Mycite Figure 15a) ANIMATION: The line segments draw in until a circle is formed. The circle rotates.	Image (Mycite Figure 15b) ANIMATION: The phone expands to fill the screen, the rest of the scene fades.	Image (Mycite Figure 15c) ANIMATION: The shot stays on the phone. An indicator pops over the "get started" button to indicate a click.	Image (Mycite Figure 15d) ANIMATION: Shot fades to disclaimer screen.
VO: Then your patch communicates this information to the App. The App lets you view all your information and shares your Tablet information with your healthcare provider.	VO: (cont.)	VO: This app will help you set up and use your MyCite system. First, create your account, and then follow along to complete the set-up process.	VO:

02_PREPARING_YOUR_SKIN

Image (Mycite Figure 16) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 17) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 18) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 19) ANIMATION: Shot of figure fades in, slowly zooms in on the patch location. Box expands out from the bottom.
VO: There are four steps to prepare your patch. A series of videos will walk you through each step. Please follow these steps to ensure your MyCite system is set up correctly, starting with preparing your skin.	VO: (cont.)	VO: (cont.)	VO: Find a spot on your stomach, as shown here.

Image (Mycite Figure 19a) ANIMATION: Figure fully lifts up shirt to reveal the area of interest, and dotted line draws in on area of interest. Box fully expands on the bottom of the screen, and populates with relevant text from the VO.	Image (Mycite Figure 19b) ANIMATION: Figure demonstrates the cleaning process.
VO: Do not place the MyCite patch in areas where the skin is scraped, cracked, inflamed, or irritated, or in a location that overlaps the area of the most recently removed patch. If there is skin irritation, you should remove the patch.	VO: Gently clean the area with soap and water. Some men may need to trim hair in this area.

03_OPENING_YOUR_POD_&_STRIP

Image (Mycite Figure 20) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 21) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 22) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 23) ANIMATION: MyCite packaging moves in from left
VO:	VO: Now we'll help you open your pod and adhesive strip. Together they will create your patch.	VO: (cont.)	VO: Inside the Abilify MyCite kit, you'll find Part 2, the pod and the strips.

Image (Mycite Figure 23a) ANIMATION: main packaging exits left, pod + patch packaging enters from right	Image (Mycite Figure 23b) ANIMATION: pod + patch packaging exits left, pod + patch models move in from right and spin in space.	Image (Mycite Figure 23c) ANIMATION: Hand places pod on table	Image (Mycite Figure 23d) ANIMATION: Hand places strip on table.
VO: (cont.)	VO: Take out your pod and strip. DO NOT dispose of this Pod. You will use this Pod throughout your treatment on MyCite. Your app will prompt you each week to change your strip."	VO: Place the pod and strip on a flat surface near your phone.	VO: (cont.)

04_PAIRING YOUR PATCH

Image (Mycite Figure 24) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 25) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 26) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 27) ANIMATION: Fade to shot of table with generic phone, the strip and the pod.
VO:	VO:	VO:	VO: Your Pod and Strip should be on a flat surface near your phone. We'll show you how to connect your patch.

Image (Mycite Figure 27a) ANIMATION: A hand picks up the pod and another hand holds the strip steady.	Image (Mycite Figure 27b) ANIMATION: The pod is inserted into the strip	Image (Mycite Figure 27c) ANIMATION: Once the pod is slotted, the light blinks green.	Image (Mycite Figure 27d) ANIMATION: The hands exit and the shot stays on the slotted strip with the light blinking green.
VO: Insert the pod into the strip until you hear a click, then wait for the blinking green light.	VO: (cont.)	VO: This signals that the pod is inserted correctly creating your patch, and is now connected to your phone.	VO:

05_APPLYING_YOUR_PATCH

Image (Mycite Figure 28) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 29) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 30) ANIMATION: Four lines of copy fade in. A rectangle expands from the left to highlight the current chapter title	Image (Mycite Figure 31) ANIMATION: The shot fades to the shot of the prepared location on the torso from video 2
VO:	VO: And now we'll help you apply your Patch	VO: (cont.)	VO: You must place the Patch on your stomach, as shown here.

Image (Mycite Figure 31a) ANIMATION: Dotted line appears around the target location.	Image (Mycite Figure 31b) ANIMATION: Shot fades to a view of the back of the patch, and a hand peels off both parts of the paper backing.	Image (Mycite Figure 31c) ANIMATION: Hand places the patch on the designated spot on the torso.	Image (Mycite Figure 31d) ANIMATION: The fingers smooth out the edges of the strip.
VO: Unlike other Patches you may have seen, the MyCite Patch will only work if it's placed on your stomach . Remember, the Patch does not contain any medication.	VO: If you haven't already, peel off the large piece of paper backing. Then peel off the small piece. Try not to wrinkle the Patch.	VO: Standing in a comfortable, upright position, apply the Patch over the area you've prepared on your stomach.	VO: Then, smooth out any bubbles with your fingers, like this. Keep the patch on when showering, swimming, or exercising. Put the patch in a new location each time you apply a new strip.

06_TAKING_YOUR_TABLET

Image (Mycite Figure 32) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 33) ANIMATION: A 3D model of the MyCite bottle fades in and rotates slowly in place.	Image (Mycite Figure 34) ANIMATION: MyCite bottle exits to the left, and the tablet icon enteres from the right.	Image (Mycite Figure 35) ANIMATION: Label for tablet draws in.
VO:	VO: Inside the Abilify MyCite kit, you'll find the container labeled "Part 3 the Tablets," only the Abilify MyCite tablets will work with MyCite.	VO:	VO: Take your Abilify MyCite tablet now, unless you have already taken it today.

Image (Mycite Figure 35a) ANIMATION: Tablet moves to the left and glass moves in from the right. Plus sign draws in.	Image (Mycite Figure 35b) ANIMATION: The tablet is crossed out	Image (Mycite Figure 35c) ANIMATION: The crossed-out tablet cracks	Image (Mycite Figure 35d) ANIMATION: Shot of tablet fades to white, a generic phone with the verification screen moves in from the bottom.
VO: Be sure to take it with plenty of water.	VO: Swallow your tablet whole; do not divide, crush, or chew. Remember to take your medication as prescribed by your doctor.	VO: (cont.)	VO: Once you've taken your tablet, your App will let you know when your Tablet has registered.

Image (Mycite Figure 35e) ANIMATION: Generic phone is centered on screen.
VO: Do not change your medication pattern or dosage based on what MyCite shows you. If you want to change your medication regimen, consult your doctor.

07_USING_YOUR_APP

Image (Mycite Figure 36) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 37) ANIMATION: Fade in on app home screen	Image (Mycite Figure 38) ANIMATION: App toolbar is highlighted	Image (Mycite Figure 39) ANIMATION: Highlight narrows to the menu, patch status, and help buttons when mentioned in the VO.
VO:	VO: Now, let's get to know your MyCite App.	VO: This is your toolbar. At the top, you'll see three icons:	VO: The menu, the patch status, and help.

Image (Mycite Figure 39a) ANIMATION: Highlight returns to the patch status button. A tap occurs and the patch status turns green.	Image (Mycite Figure 39b) ANIMATION: After a tap on the menu button, the menu expands from left.	Image (Mycite Figure 39c) ANIMATION: After a tap on "Weekly View", the perspective rotates and the weekly view screen fades in.	Image (Mycite Figure 39d) ANIMATION: A Checkmark is highlighted, then an X and finally an exclaimation.
VO: Most important is the patch status button. A red Check Patch button means your patch is not working properly. Tap the button to review your patch status and to resolve any issues, such as changing your patch every seven days. A green Patch OK button means your patch is working properly.	VO:Next is the menu.	VO: Here, you can view your information for past weeks.	VO: A green checkmark indicates that your tablet has registered. An X indicates when a tablet has not registered. An exclaimation point shows where more than one tablet has registered.

Image (Mycite Figure 39e) ANIMATION: Highlight fades, a tap expands the menu and another tap on "Monthly View" a moment later.	Image (Mycite Figure 39f) ANIMATION: Monthly View fades in.	Image (Mycite Figure 39g) ANIMATION: Navigation buttons are highlighted.	Image (Mycite Figure 39h) ANIMATION: Highlight fades, then menu fades to profile view
VO: You can also view your historical information for past months.	VO: First, you will see your tablet information, as shown here.	VO: You can also view your mood, rest, and activity information by tapping on the icons on the top right corner of the screen.	VO:

Image (Mycite Figure 39i) ANIMATION: The profile screen fades in.	Image (Mycite Figure 39j) ANIMATION: Help button is highlighted	Image (Mycite Figure 39k) ANIMATION: A tap on the help button fades to the help screen.
VO: Here, you can update your personal details, such as your name or your phone number.	VO: Finally, you'll notice the help button on the far right side.	VO:

08_USING_YOUR_TIMELINE

Image (Mycite Figure 40) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 41) ANIMATION: Fades in on the home screen.	Image (Mycite Figure 42) ANIMATION: Timeline is highlighted.	Image (Mycite Figure 43) ANIMATION: Timeline begins to scroll.
VO:	VO: Now that we have reviewed the navigation, let's take a look at your timeline.	VO: This is your timeline, which is the home screen for the app. Your most recent information is always at the top.	VO:

Image (Mycite Figure 43a) ANIMATION: Timeline scrolls to Mood card.	Image (Mycite Figure 43b) ANIMATION: Timeline scrolls to Tablet	Image (Mycite Figure 43c) ANIMATION: Timeline scrolls to My Rest card.	Image (Mycite Figure 43d) ANIMATION: Timeline scrolls to Yesterday's Summary card.
VO: My Mood helps you record how you are feeling.	VO: Your Tablet Status shows whether or not your Abilify MyCite tablet has registered.	VO: My Rest shows how much you've rested and lets you rate your rest.	VO: Finally, if you want to see yesterday's data, Yesterday's Summary gives you a view of all your information from the day before.

09_MENU_OVERVIEW

Image (Mycite Figure 44) ANIMATION: MyCite logo fades in, followed by section title	Image (Mycite Figure 45) ANIMATION: Fades in on the home screen. Immediately a tap on the menu expands it.	Image (Mycite Figure 46) ANIMATION: A tap on the activity button brings up the activity modal.	Image (Mycite Figure 47) ANIMATION: The activity modal fades, and a tap on Weekly View rotates the screen and fades in the Weekly View screen.
VO:	VO: The MyCite app menu screen has several key features.	VO: Tap here to view your activity, which is measured in how many steps you take per day.	VO: Tap Weekly View to see your tablet, mood, rest, and activity information from the past week. You can scroll through all your information from past weeks as well. You can turn your phone to see the full chart.

Image (Mycite Figure 47a) ANIMATION: Green checkmark is highlighted, then red X.	Image (Mycite Figure 47b) ANIMATION: Highlight fades, a tap brings up the menu.	ANIMATION: A tap on Monthly View brings up the Monthly Tablet status screen.	ANIMATION: Tap on mood icon brings up Mood screen.
VO: When you've taken your Abilify MyCite tablet, it will look like this. On any days you haven't taken your tablet, it will look like this.	VO:	VO: Tap Monthly View to see all your information from the past month. First, you'll see your tablet information.	VO: You can then tap the icons in the upper right corner to see your mood information,

10_ENTER_YOUR_MOOD

11_RATE_YOUR_REST

30 tablets
Rx only
NDC 59148-029-61

New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)
30-Day Starter Kit

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

2 mg

Principal Display Panel (Starter Kit Carton)

30 tablets
Rx only
NDC 59148-029-72

For
New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)

Maintenance Kit (tablets with sensor & strips)

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

2 mg

Principal Display Panel (Maintenance Kit Carton)

30 tablets
Rx only
NDC 59148-030-61

New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)
30-Day Starter Kit

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

5 mg

Principal Display Panel (Starter Kit Carton)

30 tablets
Rx only
NDC 59148-030-72

For
New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)

Maintenance Kit (tablets with sensor & strips)

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

5 mg

Principal Display Panel (Maintenance Kit Carton)

30 tablets
Rx only
NDC 59148-031-61

New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)
30-Day Starter Kit

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

10 mg

Principal Display Panel (Starter Kit Carton)

30 tablets
Rx only
NDC 59148-031-72

For
New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)

Maintenance Kit (tablets with sensor & strips)

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

10 mg

Principal Display Panel (Maintenance Kit Carton)

30 tablets
Rx only
NDC 59148-032-61

New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)
30-Day Starter Kit

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

15 mg

Principal Display Panel (Starter Kit Carton)

30 tablets
Rx only
NDC 59148-032-72

For
New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)

Maintenance Kit (tablets with sensor & strips)

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

15 mg

Principal Display Panel (Maintenance Kit Carton)

30 tablets
Rx only
NDC 59148-033-61

New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)
30-Day Starter Kit

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

20 mg

Principal Display Panel (Starter Kit Carton)

30 tablets
Rx only
NDC 59148-033-72

For
New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)

Maintenance Kit (tablets with sensor & strips)

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

20 mg

Principal Display Panel (Maintenance Kit Carton)

30 tablets
Rx only
NDC 59148-034-61

New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)
30-Day Starter Kit

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

30 mg

Principal Display Panel (Starter Kit Carton)

30 tablets
Rx only
NDC 59148-034-72

For
New 2-Component
Patch Design

Abilify MyCite^®
(aripiprazole tablets with sensor)

Maintenance Kit (tablets with sensor & strips)

Dispense the accompanying Medication Guide to each patient.

Needs a compatible mobile device.
Keep Abilify MyCite^® components out of the reach of children. Swallow tablets whole. Do not divide, crush or chew.

30 mg

Principal Display Panel (Maintenance Kit Carton)