Aripiprazole

Class

• Atypical Antipsychotic (Second-Generation)

Indications

• Schizophrenia in adults and adolescents (13+ years)
• Bipolar I disorder (manic or mixed episodes) in adults and children (10+ years)
• Adjunct treatment for major depressive disorder (MDD) in adults
• Irritability associated with autism in children (6–17 years)
• Tourette syndrome in children (6–18 years)

Mechanism of Action

• Partial agonist at dopamine D2 and serotonin 5-HT1A receptors
• Antagonist at serotonin 5-HT2A receptors
• Balances dopamine and serotonin activity, stabilizing mood and reducing psychotic symptoms

Dosage and Administration

• Schizophrenia:
  • Adults: 10–15 mg daily, can be increased up to 30 mg/day
  • Adolescents: 10 mg daily, adjust based on response
• Bipolar Disorder:
  • Adults: Starting dose 15 mg daily as monotherapy or adjunct therapy
  • Children: 10 mg daily, adjust based on response
• Major Depressive Disorder:
  • 2–5 mg daily as an adjunct to antidepressants, maximum 15 mg/day
• Autism-Associated Irritability:
  • Starting dose 2 mg daily, titrate to 5–15 mg daily based on response
• Tourette Syndrome:
  • 5–20 mg daily based on body weight and clinical response
• Administer with or without food

Forms Available

• Tablets: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
• Orally disintegrating tablets (ODT): 10 mg, 15 mg
• Oral solution: 1 mg/mL
• Injectable: Extended-release injection for monthly use

Brand Names and Manufacturers

• Abilify (Otsuka Pharmaceutical)
• Aristada (Extended-release injection, Alkermes)
• Generic versions available

Cost

• Oral tablets: $10–$50 for generic; $500–$1,000 for brand-name per month
• Extended-release injection: $1,500–$2,000 per dose

Contraindications

• Hypersensitivity to aripiprazole or its components

Precautions

• Increased risk of suicidal thoughts in adolescents and young adults (monitor closely)
• Increased risk of mortality in elderly patients with dementia-related psychosis (not approved for this use)
• Use caution in patients with a history of seizures
• Risk of neuroleptic malignant syndrome (NMS)
• May cause or worsen metabolic changes (weight gain, hyperglycemia, dyslipidemia)

Side Effects

• Common: Nausea, vomiting, dizziness, drowsiness, insomnia, restlessness (akathisia)
• Less common: Weight gain, fatigue, constipation, headache
• Rare but serious:
  • Neuroleptic Malignant Syndrome (fever, rigidity, altered mental status)
  • Tardive Dyskinesia (involuntary movements, often irreversible)
  • Severe allergic reactions (rash, swelling, difficulty breathing)

Drug Interactions

• CYP3A4 inhibitors (e.g., ketoconazole): Increase aripiprazole levels
• CYP3A4 inducers (e.g., rifampin): Decrease aripiprazole levels
• CNS depressants (e.g., benzodiazepines, alcohol): Increased sedative effects
• Antihypertensives: May enhance blood pressure-lowering effects
• Other dopamine modulators: Increased risk of side effects

Monitoring Parameters

• Symptom improvement (mood stabilization, reduction in psychotic symptoms)
• Weight, blood sugar, and lipid profile for metabolic changes
• Signs of extrapyramidal symptoms (EPS) or tardive dyskinesia
• Liver function tests in patients with hepatic impairment

Patient Counseling Points

• Take medication at the same time daily to maintain steady blood levels
• Avoid alcohol to reduce the risk of drowsiness or sedation
• Report new or worsening symptoms such as suicidal thoughts, severe restlessness, or muscle stiffness
• Be aware of potential weight gain; maintain a healthy diet and exercise
• Extended-release injection requires monthly administration by a healthcare provider
• Do not stop abruptly; consult your doctor before discontinuing

FAQs About Aripiprazole
Q1: How long does it take for aripiprazole to work?

• Initial improvements may appear within 1–2 weeks; full effects can take 4–6 weeks

Q2: Is aripiprazole addictive?

• No, it is not addictive but must be taken consistently for effectiveness

Q3: Can aripiprazole cause weight gain?

• Yes, weight gain is a possible side effect; monitoring and lifestyle adjustments may help

Q4: Can I take aripiprazole during pregnancy?

• Discuss with your doctor; used only if benefits outweigh potential risks

Q5: What should I do if I miss a dose?

• Take it as soon as you remember, but skip it if it’s close to the next dose; do not double doses

Q6: Are there alternatives to aripiprazole?

• Yes, alternatives include risperidone, olanzapine, quetiapine, or lurasidone

Q7: Does aripiprazole help with anxiety?

• Not specifically approved for anxiety but may help in conditions like bipolar disorder with anxiety symptoms

Q8: What is the difference between oral and injectable aripiprazole?

• Oral forms are taken daily; injections are long-acting and administered monthly