Aripiprazole

Aka: Aripiprazole, Abilify

1. Class
   1. Atypical Antipsychotic (Second Generation agent)
2. Indications
   1. Schizophrenia
   2. Bipolar Disorder
   3. Major Depression (adjunct in refractory cases)
3. Advantages
   1. Lower weight gain than other second generation Antipsychotic agents
   2. Lower diabetes risk than other second generation Antipsychotic agents
4. Precautions
   1. Despite generic in 2015, price still approaches $800 per month
   2. Primary role remains as an Antipsychotic for Schizophrenia and Bipolar Disorder
      1. Only consider adjunctively in severe Major Depression refractory to other measures
5. Drug Interactions
   1. Increase Antipsychotic levels (toxicity risk): Monitor for Aripiprazole toxicity
      1. Clarithromycin
      2. Erythromycin
      3. Grapefruit juice
   2. Increase Antipsychotic levels (toxicity risk): Lower Aripiprazole dose to half
      1. Itraconazole
      2. Ketoconazole
      3. Quinidine
   3. Decrease Antipsychotic levels (lower efficacy)
      1. Barbiturates
      2. Carbamazepine
      3. Phenytoin
6. Efficacy: Depression
   1. Depression remits in 25% of patients by 6 weeks (effects may be seen by 1 week)
7. Adverse Effects
   1. Headache
   2. Restlessness or agitation
   3. Insomnia
   4. Anxiety
   5. Extrapyramidal Side Effects in up to 17% of patients
   6. Nausea
   7. Constipation
   8. Fatigue or sedation
   9. Impulse control behaviors (rare)
      1. Behaviors seen with other Dopamine Agonists (e.g. Compulsive Gambling, hypersexuality, shopping, eating)
      2. Moore (2014) JAMA Intern Med 174(12):1930-3 [PubMed]
8. Monitoring
   1. See Antipsychotic
9. Dosing: Schizophrenia or Bipolar Disorder
   1. Starting dose: 10-15 mg once daily
   2. Maximum dose: 30 mg/day
10. Dosing: Major Depression (in refractory and atypical cases)
    1. Starting dose: 2-5 mg/day
    2. Maximum dose: 15 mg/day (up to 30 mg/day has been used)