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Aripiprazole

Brands and Forms

  • Abilify
    • tablet: 2mg, 5mg, 10mg, 15mg, 20mg 30mg
    • oral solution: 1mg/ml
    • intramuscular injection: 7.5mg/ml
  • Abilify Discmelt
    • orally disintegrating tablet: 10mg, 15mg

Uses of Aripiprazole

Aripiprazole can be used in the treatment of Psychotic Disorders, Bipolar Disorder, Depressive Disorders, PTSD, and OCD.

Apriprazole can also be used in the management of behavioral disturbances, such as agitation and impulsivity, that can occur in various conditions like Impulse-Control Disorders, Disruptive Behavior Disorders, and Borderline Personality Disorder.

Unlike most other Atypical Antipsychotic, Aripiprazole tends not to cause significant weight gain or metabolic side-effects (elevated glucose, lipids and cholesterol), and for this reason may be a preferred choice in certain cases.

How Aripiprazole Works

Aripiprazole is an Atypical Antipsychotic. It is a partial agonist at dopamine D2 and serotonin 5HT1a receptors, and is an antagonist at the serotonin 5HT2a receptor.

Cautions when Using Aripiprazole

In elderly individuals with Dementia, use of Antipsychotics has been associated with increased rates of sudden death. It is unclear whether the antipsychotic use is a cause, or simply a marker, of deteriorating health in these individuals.

Individuals with Parkinson disease or Lewy-Body Dementia may have increased sensitivity to Aripiprazole, which may manifest as confusion, obtundation, severe extrapyramidal symptoms, and neuroleptic malignant syndrome.

Dosing of Aripiprazole

For Bipolar Disorder and Psychotic Disorders, the usual dose range is 15-30mg/day, and it is taken once daily, usually at bedtime given the occurrence of somnolence as a side-effect,though any time of day would be acceptable. It is usually started at 10 or 15mg daily, and increased in 5 or 10mg increments as needed. Some patients may require as little as 2-5mg a day.

In children and adolescents ages 10-17, start with 2mg/day, and then increase to 5mg/day after 2 days, and to the target dose of 10mg/day after 2 additional days. Subsequent dose increases should be in increments of 5mg/day.

For most other conditions, a starting dose for adults is 2-5mg/day, with increases of 5mg made at intervals of no less than one week.

When wanting to stop Aripiprazole, the dose should be gradually tapered over a period of 4-6 weeks.

Onset of action

Manic and psychotic symptoms can improve within 1 week of use, but full therapeutic effect in Bipolar Disorder and Psychotic Disorders may take several weeks. If there is no significant effect after 4 weeks at the maximum tolerated dose, then it may not work at all.

Acute agitation can improve after a single dose.

For other conditions, 4-6 weeks may be needed to see a therapeutic effect.

Kidney impairment

Dose adjustment not necessary.

Liver impairment

Dose adjustment not necessary.

Side-effects of Aripiprazole

Below is a list of most of the reported side-effects of Aripiprazole. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Cardiovascular: tachycardia (rapid heart beat); increased or decreased blood pressure, peripheral edema.

Central Nervous System: headache; somnolence; extrapyramidal symptoms; insomnia; tremor; dizziness; abnormal coordination; weakness; fever; seizures (rare).

Dermatologic: rash; excessive perspiration.

Eyes, Ears, Nose and Throat: blurred vision; dry mouth; nasopharyngitis; nasal congestion; cough; throat pain.

Gastrointestinal: nausea; constipation; vomiting; dyspepsia; salivary hypersecretion; abdominal pain; diarrhea; weight gain (rare).

Musculoskeletal: muscle stiffness; muscle pains; muscle spasms; neuroleptic malignant syndrome (rare).

Psychiatric: anxiety (rare); agitation (rare); obsessive-compulsive symptoms (rare).

Respiratory: aspiration pneumonia (due to esophageal dysmotility; rare); dyspnea.

Common side-effects of Aripiprazole

Headache, somnolence, fatigue, extrapyramidal symptoms, agitation, insomnia,anxiety, tremor, dizziness, nausea, constipation, vomiting, dyspepsia,salivary hypersecretion.

Rare but serious side-effects of note of Aripiprazole

Aripiprazole overdose

Vomiting, sedation, agitation, confusion, arrhythmias, blood pressure changes, seizures, loss of consciousness, coma. No fatalities reported.

Aripiprazole, weight gain and metabolic syndrome

A small percentage of people taking Aripiprazole will gain about 7% of their total body weight within 8 weeks of starting the medication [ref, ref]. Metabolic side-effects, including elevated glucose and lipids can also occur, which in the long-term increase the risk for heart disease and vascular problem.

See here for further information on these side-effects, and how they can be managed.

Aripiprazole and pregnancy

Category C: some animal studies show adverse effects at very high doses, but no controlled human studies have been done; can be used in pregnancy if benefits outweigh potential risks.

Medical Monitoring for Aripiprazole

Monitoring for weight gain and a metabolic syndrome requires the following measures to be taken prior to starting the medication, then monthly for the first 3 months of use, and then every 3 months:

  • Body Mass Index (BMI)
  • waistline circumference at umbilicus
  • blood pressure
  • fasting blood glucose
  • fasting blood lipids and cholesterol

Drug Interactions with Aripiprazole

  • Aripiprazole blood levels may be increased by Ketaconazole, Nefazodone, Fluvoxamine, Fluoxetine, Paroxetine, Duloxetine, and Quinidine. Consider reducing the Aripiprazole dose by 50% when combined with one of these other medications.
  • Aripiprazole blood levels may be decreased by Carbamazepine. Consider doubling the dose of Aripiprazole when used in combination with Carbamazepine.
  • Aripiprazole may enhance effects of antihypertensives
  • Aripiprazole may antagonize levodopa and stimulants.