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
  • Acetaminophen; Tramadol
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  • Fluvoxamine
  • food
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  • grapefruit juice
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  • Hydrocodone
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  • Voriconazole
  • Vorinostat
  • Zafirlukast
  • Zaleplon
  • Ziprasidone
  • Zolpidem
  • Zonisamide
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