Second Generation (Atypical) Antipsychotic
“ALERT: US Boxed Warning
Increased mortality in elderly patients with dementia-related psychosis:
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Aripiprazole is not approved for the treatment of patients with dementia-related psychosis.
Suicidality and antidepressant drugs:
Antidepressants increased the risk of suicidal thoughts and behaviour in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behaviour with antidepressant use in patients older than 24 years of age; there was a reduction in risk with antidepressant use in patients 65 years of age and older. Closely monitor all antidepressant-treated patients for clinical worsening and for the emergence of suicidal thoughts and behaviours. Advise families and caregivers of the need for close observation and communication with the prescriber. The safety and efficacy of aripiprazole tablets with sensors have not been established in pediatric patients.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
Aripiprazole/Abilify is a quinolinone antipsychotic that binds various neurotransmitter receptors in the brain such as serotonin (5-HT1A, 5-HT2A, 5-HT2C, 5-HT7), dopamine (D2, D3, D4), histamine (H1), and adrenergic (Alpha1). Does not affect cholinergic receptors. Has mixed effects at the various receptors (inhibits some and activates others). Brains response to altered chemistry results in desired effects.
Indications For Use
Aripiprazole/Abilify is officially indicated for acute manic or mixed episodes in bipolar disorder, adjunct for treatment-resistant major depressive disorder, or schizophrenia. It may also be prescribed off-label for use in acute severe agitation or aggression, delusional disorder, delusional infestation, Huntington disease-associated chorea, or treatment resistant obsessive-compulsive disorder. (maybe used for other conditions not listed)
Before starting Aripiprazole/Abilify make sure your physician is aware of any allergies or medications you currently take, if you have cardiovascular disease, Parkinson disease, dementia, a history of seizures or are pregnant or breastfeeding. Suicidal ideation is inherent with bipolar disorder or psychotic illness so caution must be used and any major changes in personality or mood should be reported to the physician immediately.
This medication also required regular blood work and follow up with your physician to monitor for adverse reactions
2- 30mg once daily depending on what condition it is used for and patient response
Pharmacist Tips On Using
How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature.
You Need to Avoid: Operating heavy machinery or driving at least until you know how the medication affects you. Do not stop this medication suddenly, make sure your physician is aware and can create a tapering schedule so you can come off slowly and prevent any withdrawal symptoms. This medication has many drug interactions so ask your pharmacist before starting any over the counter medications or supplements.
Decreased HDL (good cholesterol), hyperglycemia, increased LDL (bad cholesterol), weight gain, constipation, nausea, vomiting, agitation, akathisia, anxiety, dizziness, drowsiness, fatigue, headache, tremor, insomnia, withdrawal syndrome, neuroleptic malignant syndrome, and extrapyramidal reaction (involuntary movement)
Note- this is not a complete list of side effects, only common ones and are generally dosage-dependent. When higher doses are required the physician has weighed the risks and found the benefits to be greater, however regular monitoring (blood sugar, cholesterol, blood pressure, etc.) is important to make sure this does not change
Frequently Asked Questions
- Why would my doctor give me an antipsychotic? Does this mean I am psychotic?
This medication can be used for many conditions outside of its original classification. It commonly is also used for nonpsychotic mood disorders, but this class of medication was given its name back when we knew a lot less about their capabilities.
- This medication has a lot of scary side effects, is it safe?
All medications have side effects however this medication works on a lot of different neurotransmitter receptors in the brain which can lead to a variety of intentional and unintentional effects. These are mostly dosage dependant and in lower doses the risk is minimal. In all cases regular lab work will allow your physician to see if your blood sugar, cholesterol etc. start to move in the wrong direction so action can be taken before they become a problem.
- What are extra-pyramidal reactions?
Blocking dopamine in the extrapyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders. This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug-induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities). These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine. If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
- What is Neuroleptic Malignant Syndrome?
NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly. Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status. As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures. Seek medical attention immediately if this reaction is suspected.