II. Indications
- Schizophrenia
- Bipolar Disorder
- Major Depression (adjunct in refractory cases)
- Autism (irritability)
- Tourette's Syndrome
III. Advantages
- Lower weight gain than other second generation Antipsychotic agents
- Lower diabetes and Hyperglycemia risk than other second generation Antipsychotic agents
- Lower risk of Hyperlipidemia and Hyperprolactinemia than other second generation Antipsychotic agents
IV. Precautions
- Despite generic in 2015, price still approaches $800 per month
- Primary role remains as an Antipsychotic for Schizophrenia and Bipolar Disorder
- Only consider adjunctively in severe Major Depression refractory to other measures
V. Mechanism
- Atypical Antipsychotic (Second Generation agent)
- Dopamine D2 and D3 partial Agonist
- Serotonin 5HT1A partial Agonist
- Serotonin 5HT2A receptor Antagonist
VI. Drug Interactions
- Metabolized by CYP3A3/4 and CYP2D6
- Increase Antipsychotic levels (toxicity risk): Monitor for Aripiprazole toxicity
- CYP3A3/4 Inhibitors increase Antipsychotic levels (toxicity risk): Lower Aripiprazole dose to one quarter to one half dose
-
CYP3A3/4 Inducers decrease Antipsychotic levels (lower efficacy)
- Double Aripiprazole dose over 1-2 weeks while taking these meds (and avoid longer than 2 weeks with IM Aripiprazole)
- Barbiturates
- Carbamazepine
- Phenytoin
VII. Efficacy: Depression
- Major Depression remits in 25% of patients by 6 weeks (effects may be seen by 1 week)
VIII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
IX. Adverse Effects
- Headache
- Restlessness or Agitation
- Insomnia
- Anxiety
- Extrapyramidal Side Effects in up to 17% of patients
- Akathisia
- Nausea
- Constipation
- Fatigue or sedation
- Impulse control behaviors (rare)
- Behaviors seen with other Dopamine Agonists (e.g. Compulsive Gambling, hypersexuality, shopping, eating)
- Moore (2014) JAMA Intern Med 174(12):1930-3 [PubMed]
X. Monitoring
- See Antipsychotic
XI. Dosing: Schizophrenia or Bipolar Disorder (or irritability in Autism)
- Oral Dosing
- Adult
- Start: 10-15 mg once daily
- Maximum dose: 30 mg/day
- Dose >15 mg do not appear more effective than the 15 mg dose
- Child (age 13 to 17 years)
- Start: 2 mg orally daily
- May increase to 5 mg daily after 2 days
- May increase to 10 mg daily after another 2 days
- Target: 10 mg/day
- Maximum: 15-30 mg/day (not more effective than 10 mg/day)
- Adult
- Monthly IM Dosing
- Trial oral dosing before administering IM Dose
- Oral dosing is coadministered only with the first IM dose
- Continue oral dose daily only for the first 14 days
- Abilify Maintena 400 mg IM once monthly
- Lower dose of 300 mg IM may be used to reduce adverse effects
- Aristada
- Oral dosing is coadministered only with the first IM dose
- Continue oral dose daily only for the first 21 days
- Lower dose (equivalent to 10 mg/day): 441 mg IM monthly
- Higher dose (equivalent to 15 mg/day)
- Monthly: 662 mg IM
- Every 6 weeks: 882 mg IM
- Every 2 months: 1064 mg IM
- Oral dosing is coadministered only with the first IM dose
-
Agitation
- Adults: 9.75 mg IM (range 5.25 to 15 mg IM)
- May repeat after 2 hours, up to maximum of 30 mg/day
XII. Dosing: Major Depression (in refractory and atypical cases, as adjunctive therapy)
- Starting dose: 2-5 mg/day
- Maximum dose: 15 mg/day (up to 30 mg/day has been used)
XIII. Dosing: Tourette's Syndrome
- Child (age 6 to 18 years)
- Start: 2 mg orally daily
- May increase to 5 mg daily after 2 days
- May increase weekly to a maximum of 10 mg daily (if weight <50 kg) or 20 mg daily (if weight >50 kg)
XIV. Resources
XV. References
- (2016) Med Lett Drugs Ther 58(1510): 160-5
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| aripiprazole (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ARIPIPRAZOLE 1 MG/ML SOLUTION | Generic | $1.09 per ml |
| ARIPIPRAZOLE 10 MG TABLET | Generic | $0.13 each |
| ARIPIPRAZOLE 15 MG TABLET | Generic | $0.14 each |
| ARIPIPRAZOLE 2 MG TABLET | Generic | $0.13 each |
| ARIPIPRAZOLE 20 MG TABLET | Generic | $0.26 each |
| ARIPIPRAZOLE 30 MG TABLET | Generic | $0.28 each |
| ARIPIPRAZOLE 5 MG TABLET | Generic | $0.15 each |
| abilify (on 12/15/2021 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ABILIFY 10 MG TABLET | Generic | $0.13 each |
| ABILIFY 15 MG TABLET | Generic | $0.14 each |
| ABILIFY 5 MG TABLET | Generic | $0.15 each |
| ABILIFY MAINTENA ER 300 MG SYR | $1,827.31 each | |
| ABILIFY MAINTENA ER 300 MG VL | $1,834.87 each | |
| ABILIFY MAINTENA ER 400 MG SYR | $2,444.19 each | |
| ABILIFY MAINTENA ER 400 MG VL | $2,445.84 each | |
| aristada (on 4/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ARISTADA ER 1,064 MG/3.9 ML SYR | $860.02 per ml | |
| ARISTADA ER 441 MG/1.6 ML SYRN | $871.17 per ml | |
| ARISTADA ER 662 MG/2.4 ML SYRN | $870.78 per ml | |
| ARISTADA ER 882 MG/3.2 ML SYRN | $871.02 per ml | |