Aripiprazole

Aripiprazole Brand NameS

Abilify | Abilify Discmelt | Abilify Maintena | Abilify Mycite | Aristada

What is Aripiprazole

Aripiprazole is an atypical antipsychotic in a class commonly known as dopamine system stabilizers (DSSs).

Aripiprazole is a partial dopamine agonist, in contrast to most other antipsychotics that are full dopamine antagonists.

Atypical antipsychotics such as aripiprazole are first-line treatment options for the management of schizophrenia and related disorders, with the exception of clozapine.

Both negative and cognitive symptoms of schizophrenia are reduced by aripiprazole and motor side effects appear to be minimal compared with many other antipsychotics.

Oral aripiprazole is used in adults with schizophrenia, bipolar I disorder, and as adjunct therapy in major depressive disorder (MDD).

Oral aripiprazole has also proven effective in the treatment of pediatric patients with the following conditions: adolescents with schizophrenia, children 10 years and older with bipolar I disorder, and children 6 years and older with irritability associated with autistic disorder or with tics due to Tourette’s syndrome.

The American Academy of Neurology practice guideline states that aripiprazole is probably more likely than placebo to reduce tic severity in patients with Tourette’s syndrome or chronic tic disorders; however, there is insufficient evidence to determine the efficacy of aripiprazole relative to other antipsychotics used to treat tics.

Aripiprazole was the first oral antipsychotic to be marketed as a drug-device combination product (Abilify Mycite) comprised of aripiprazole tablets embedded with an Ingestible Event Marker (IEM) sensor intended to track compliance in adults.

An immediate-release injection is approved for acute agitation due to schizophrenia or bipolar 1 disorder in adults.

Aripiprazole is also available as distinct intramuscular depot injection products for maintenance therapy in adults, an extended-release monthly injection (Abilify Maintena) for schizophrenia and bipolar I disorder, and an extended-release injection with efficacy for up to 2 months (Aristada) for schizophrenia.

Aristada Initio is an extended-release intramuscular injection for single-dose administration as an option in patients receiving their first dose of Aristada or following a missed dose of Aristada.

Aristada Initio uses a smaller particle size of aripiprazole lauroxil than Aristada, enabling faster dissolution and attainment of desired aripiprazole plasma concentrations.

As with all atypical antipsychotics, the labels include a boxed warning regarding an increased mortality risk in elderly patients with dementia-related psychosis.

Indications

1. agitation
2. autistic disorder
3. behavioral or psychological symptoms of dementia
4. bipolar disorder
5. depression
6. mania
7. schizophrenia
8. Tourette’s syndrome

Side Effects

1. abdominal pain
2. agitation
3. agranulocytosis
4. akathisia
5. akinesia
6. alopecia
7. amenorrhea
8. anaphylactoid reactions
9. angina
10. angioedema
11. anorexia
12. anxiety
13. appetite stimulation
14. arthralgia
15. asthenia
16. atrial fibrillation
17. atrial flutter
18. AV block
19. blurred vision
20. bradycardia
21. cardiac arrest
22. chest pain (unspecified)
23. choreoathetosis
24. complex sleep-related behaviors
25. confusion
26. constipation
27. cough
28. delirium
29. dental pain
30. depression
31. diabetes mellitus
32. diabetic ketoacidosis
33. diarrhea
34. diplopia
35. dizziness
36. drowsiness
37. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
38. dyspepsia
39. dysphagia
40. dyspnea
41. dystonic reaction
42. elevated hepatic enzymes
43. epistaxis
44. fatigue
45. fecal incontinence
46. fever
47. gastroesophageal reflux
48. gynecomastia
49. headache
50. hepatitis
51. hiccups
52. hirsutism
53. hyperbilirubinemia
54. hypercholesterolemia
55. hyperglycemia
56. hyperhidrosis
57. hyperlipidemia
58. hyperprolactinemia
59. hypersalivation
60. hypertension
61. hyperthermia
62. hypertonia
63. hypertriglyceridemia
64. hypoglycemia
65. hypokalemia
66. hyponatremia
67. hypotension
68. hypothermia
69. hypotonia
70. impaired cognition
71. impotence (erectile dysfunction)
72. impulse control symptoms
73. injection site reaction
74. insomnia
75. irritability
76. jaundice
77. laryngospasm
78. lethargy
79. leukopenia
80. libido decrease
81. libido increase
82. mania
83. mastalgia
84. memory impairment
85. menstrual irregularity
86. musculoskeletal pain
87. myalgia
88. myasthenia
89. myocardial infarction
90. myoclonia
91. nasal congestion
92. nausea
93. neuroleptic malignant syndrome
94. neutropenia
95. nocturia
96. orgasm dysfunction
97. orthostatic hypotension
98. palpitations
99. peripheral edema
100. pharyngitis
101. photophobia
102. photosensitivity
103. polydipsia
104. priapism
105. pruritus
106. pseudoparkinsonism
107. psychomotor impairment
108. QT prolongation
109. rash
110. restlessness
111. rhabdomyolysis
112. seizures
113. serotonin syndrome
114. SIADH
115. sinus tachycardia
116. skin irritation
117. somnambulism
118. Stevens-Johnson syndrome
119. stroke
120. suicidal ideation
121. syncope
122. tardive dyskinesia
123. thrombocytopenia
124. torsade de pointes
125. torticollis
126. toxic epidermal necrolysis
127. tremor
128. urinary incontinence
129. urinary retention
130. urticaria
131. vomiting
132. water intoxication
133. weight gain
134. weight loss
135. xerostomia

Monitoring Parameters

• AIMS assessment
• blood glucose
• CBC
• glycosylated hemoglobin A1c (HbA1c)
• LFTs
• neurologic function
• pregnancy testing
• serum creatinine
• serum electrolytes
• serum lipid profile
• serum prolactin
• thyroid function tests (TFTs)
• weight

Contraindications

• abrupt discontinuation
• agranulocytosis
• alcoholism
• ambient temperature increase
• bipolar disorder
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• cerebrovascular disease
• children
• coadministration with other CNS depressants
• coronary artery disease
• dehydration
• dementia
• diabetes mellitus
• driving or operating machinery
• dysphagia
• ensure correct formulation selection
• ethanol ingestion
• females
• geriatric
• heart failure
• hematological disease
• hypercholesterolemia
• hyperglycemia
• hyperlipidemia
• hypertension
• hyperthermia
• hypertriglyceridemia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypotension
• hypothermia
• hypovolemia
• impulse control symptoms
• leukopenia
• long QT syndrome
• magnetic resonance imaging (MRI)
• malnutrition
• mania
• myocardial infarction
• neonates
• neurological disease
• neutropenia
• obesity
• orthostatic hypotension
• Parkinson’s disease
• phenylketonuria
• poor metabolizers
• pregnancy
• pregnancy testing
• QT prolongation
• seizure disorder
• seizures
• strenuous exercise
• stroke
• suicidal ideation
• syncope
• tardive dyskinesia
• thyroid disease

Interactions

• Abarelix
• Abiraterone
• Acarbose
• Acebutolol
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
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