aripiprazole (Abilify)
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Indications
- schizophrenia
- bipolar disorder, mania[3]
- depression, including major depression[4] {FDA-approved}
- add-on treatment of depression in the elderly[13]
- autism in children
- psychosis & agitation in the elderly[10][11]
Dosage
- 2-30 PO mg QD, AM dosing[11]
- usual dose 10-30 mg/day[3]
- depression, start 2-5 mg/day, titrate up to 15 mg/day
Tabs: 2,5,10,15,20, 30 mg
Injection: for IM injection[11]
Pharmacokinetics
- antidepressant effects in 1-6 weeks[4]
- metabolized by CYP2D6 & CYP3A4
- 1/2life is ~75 hours & 94 hours for aripiprazole & dehydro-aripiprazole, respectively[16]
- for CYP2D6 poor metabolizers, the mean elimination 1/2life for aripiprazole is ~146 hours[16]
- activity is presumably primarily due to the parent drug, aripiprazole, & to a lesser extent, to its major metabolite, dehydro-aripiprazole
Adverse effects
- common:
- does NOT prolong QT interval
- may cause less weight gain than other atypical antipsychotics
- may increase risk of diabetes mellitus[2]
- esophageal dysmotility
- impaired judgement, motor skills
- neuroleptic malignant syndrome (rare)
- tardive dyskinesia
- little or no increase in risk for diabetes, dysplidemia, weight gain
- can exacerbate hyperglycemia in patients with diabetes mellitus
- weight gain, in adolescents 4.4 kg after 11 weeks of therapy[8]
- elderly
- mild hypotension[11]
- mild sedation[11]
- increased risk of stroke in elderly ?
- increased risk of parkinsonism (case of 58 yo woman) NEJM[16]
- impulse control disorder
- pathologic gambling, binge eating, compulsive shopping, & impulsive sexual behavior[14]
- black box warning[11]
- increased risk of hyperglycemia
- increased risk of cerebrovascular events
- increased risk of mortality in patients with dementia
* change aripiprazole to lamotrigine (NEJM)[16]
- drug adverse effects of antipsychotic agents
- drug adverse effects of atypical antipsychotic agents
- drug adverse effects of psychotropic agents
Mechanism of action
- "dopamine system stabilizer"
- partial dopamine D2 receptor agonist
- partial serotonin receptor 5-HT1A & 5-HT2A agonist[16]
Notes
- generic FDA-approced April 2015
- aripiprazole wth an ingestible sensor embedded (Abilify MyCite) digitally records whether & when the medication is taken FDA-approved Nov 2017[15]
- ingestible sensor transmits a message to a patch worn by the patient
- the patch then sends the information to a mobile device[15]
- not been shown to improve patient compliance
More general terms
More specific terms
References
- ↑ Prescriber's Letter 9(12):69 2002
- ↑ 2.0 2.1 2.2 Prescriber's Letter 10(11):62 2003
- ↑ 3.0 3.1 3.2 Prescriber's Letter 12(9): 2005 Role of atypical antipsychotics in treating patients with Schizophrenia: Are they better than older agents? Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211107&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 Prescriber's Letter 15(1): 2008 Treatment-Resistant Depression Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240103&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ http://www.fda.gov/cder/consumerinfo/druginfo/abilify.htm
- ↑ http://www.abilify.com
- ↑ Department of Veterans Affairs, VA National Formulary
restricted to psychiatry - ↑ 8.0 8.1 Correll CU et al Cardiometabolic Risk of Second-Generation Antipsychotic Medications During First-Time Use in Children and Adolescents JAMA. 2009;302(16):1765-1773 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19861668 <Internet> http://jama.ama-assn.org/cgi/content/short/302/16/1765
Varley CK & McClellan J Implications of Marked Weight Gain Associated With Atypical Antipsychotic Medications in Children and Adolescents JAMA. 2009;302(16):1811-1812 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19861677 <Internet> http://jama.ama-assn.org/cgi/content/short/302/16/1811 - ↑ Prescriber's Letter 17(1): 2010 Atypical Antipsychotics in Kids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260102&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 10.0 10.1 Deprecated Reference
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ FDA News Release. April 28, 2015 FDA approves first generic Abilify to treat mental illnesses. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm444862.htm
- ↑ 13.0 13.1 Lenze EJ et al Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo- controlled trial. Lancet. Published Online: 27 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26423182 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900308-6/abstract
Thomas A, O'Brien JT Management of late-life depression: a major leap forward. Lancet. Published Online: 27 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26423179 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900304-9/abstract - ↑ 14.0 14.1 FDA Safety Watch. May 3, 2016 Aripiprazole (Abilify, Abilify Maintena, Aristada): Drug Safety Communication - FDA Warns About New Impulse-control Problems. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm498823.htm
- ↑ 15.0 15.1 15.2 Brooks M FDA Clears Drug With Ingestible Digital Tracker. Medscape - Nov 14, 2017. https://www.medscape.com/viewarticle/888586
- ↑ 16.0 16.1 16.2 16.3 16.4 16.5 NEJM Knowledge+ Neurology
- ↑ HIGHLIGHTS OF PRESCRIBING INFORMATION ABILIFY<TM> (aripiprazole) Tablets https://www.otsuka-us.com/sites/g/files/qhldwo3916/files/media/static/Abilify-PI.pdf