Class: Antipsychotic
Dosage Forms. Tablet: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg; Tablet (Disintegrating): 10 mg, 15 mg; Solution: 1 mg/mL
Common FDA Label Indication, Dosing, and Titration.
1. Bipolar disorder, manic or mixed episodes: Adults, 2 mg po daily, may titrate to 15-30 mg po daily; Children >10 y, 2 mg po daily, may titrate to 10 mg po daily
2. Schizophrenia: Adults, 10-15 mg po daily, may titrate to max 30 mg/d; Children >13 y, 2 mg po daily, may titrate to 10 mg po daily
Off-Label Uses.
1. Major depressive disorder, adjunct treatment with antidepressants: 2-5 mg po daily, may titrate to 2-15 mg/d
MOA. Aripiprazole is an atypical antipsychotic agent (quinolinone derivative). It exhibits relatively high affinity for dopamine D2 and D3 receptors and serotonin 5-HT1A and 5-HT2A receptors.
Drug Characteristics: Aripiprazole
Medication Safety Issues: Aripiprazole
Drug Interactions: Aripiprazole
Adverse Reactions: Aripiprazole
Efficacy Monitoring Parameters. Improvement in schizophrenia, mania, depression.
Toxicity Monitoring Parameters. FPG and CBC prior to treatment and periodically in patients with risk factors for diabetes. Patients at high risk for suicide should be closely supervised during therapy. Monitor ECG at baseline and periodically during therapy.
Key Patient Counseling Points. Avoid activities requiring mental alertness or coordination until drug effects are realized. Drug may impair heat regulation. Drug may also lower seizure threshold. Patients with history of seizures or conditions that lower seizure threshold to report increased seizure activity. Report worsening depression, suicidal ideation, or unusual changes in behavior, especially at initiation of therapy or with dose changes. Children, adolescents, and young adults are at higher risk for these effects during the first few months of therapy. Report signs/symptoms of hyperglycemia, extrapyramidal effects, and neuroleptic malignant syndrome. Avoid sudden discontinuation. Avoid alcohol.
Clinical Pearls. Solution may be substituted for the tablet dosages on a mg-per-mg basis for up to a 25-mg dose; patients on 30-mg tablets should receive 25 mg of the solution. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.