aripiprazole ABILIFY

Class: Second Generation Antipsychotic/​arylpiperazine Quinolinone Derivative
FDA Indications: Schizophrenia, Tourette's Disorder, Acute Treatment Of Manic And Mixed Episodes Associated With Bipolar I, Adjunctive Treatment Of Major Depressive Disorder, Irritability Associated With Autistic Disorder
Off-Label Use: Anxiety, Alzheimers Disease Related Psychosis, Eating Disorders, Borderline Personality Disorder
Prescribing
Forms: 2, 5, 10, 15, 20, 30mg tablet; 10, 15mg ODT; 1 mg/mL po soln; 9.75 mg/1.3 mL IM
Dose Range: 2-30 mg/day
Starting: Start most patients at 10 mg QD to prevent agitation/akathisia, gradually increase to target dose of 15-30 mg QD.
Stopping: Due its long t½ it's reasonable to justify discontinuing w/o taper as aripiprazole essentially 'auto-tapers' itself over two weeks.
Monitoring:

NAMI drug fact sheet

Precautions
Serious Side Effects: , , ,
Possible Risk of TdP
Side Effects: headache, sedation/somnolence, dizziness, nausea, insomnia, akathisia, anxiety, agitation, EPS, activation, dyspepsia
Pharmacodynamics
1° MOA: Partial Dopamine Agonist
Target: Partial agonist at D2 & 5HT1A, antagonism at 5HT2A
Pharmacokinetics
t½: 75° TMAX: 3-5°
Substrate of: 2D6, 3A4
Inhibits: 2D6, 3A4; Induces:
Active Metabolites: Dehydroaripiprazole (t½ ~90°)
DDIs
Misc
  • - probably most "activating" in its class
  • - minimal EPS compared to other antipsychotics
  • - lacks appreciable affinity at cholinergic muscarinic receptors
  • - minimal weight gain
  • - no prolactin elevation
  • - no significant ECG Δ's; the only SGA known to actually ↓ QTc (~ -1 to -4ms)
  • - lowest propensity for orthostatic hypotension in its class
  • - no reported sexual side effects
Special Populations

Category C—Several case reports have described the use in human pregnancy without observing developmental toxicity. The animal data suggest risk, but the limited human pregnancy experience prevents a better assessment of the embryo-fetal risk. Until such data are available, the safest course is to avoid the drug in pregnancy. However, if the mother’s condition requires treatment with aripiprazole, the lowest effective dose, avoiding the 1st trimester if possible, should be used. There is a risk of extrapyramidal and/ or withdrawal symptoms in the newborn if the drug is used in the 3rd trimester.

Limited Human Data-Potential Toxicity. RID 0.9%


All atypicals may increase mortality in elderly patients by 1.7 times greater than placebo.

No dosage adjustment necessary.


No dosage adjustment necessary.

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Last updated June 10 2018 15:40:14. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.