Aripiprazole is an atypical antipsychotic used to treat schizophrenia, bipolar mania, major depressive disorder, and irritability associated with autism. It works as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors. Common side effects include headache, insomnia, nausea, and weight gain. It can cause hypotension, extrapyramidal symptoms, and elevated blood glucose or prolactin levels, so monitoring for these is important. Aripiprazole levels may interact with CYP3A4 or CYP2D6 inhibitors or inducers.
Aripiprazole is an atypical antipsychotic used to treat schizophrenia, bipolar mania, major depressive disorder, and irritability associated with autism. It works as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors. Common side effects include headache, insomnia, nausea, and weight gain. It can cause hypotension, extrapyramidal symptoms, and elevated blood glucose or prolactin levels, so monitoring for these is important. Aripiprazole levels may interact with CYP3A4 or CYP2D6 inhibitors or inducers.
Aripiprazole is an atypical antipsychotic used to treat schizophrenia, bipolar mania, major depressive disorder, and irritability associated with autism. It works as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors. Common side effects include headache, insomnia, nausea, and weight gain. It can cause hypotension, extrapyramidal symptoms, and elevated blood glucose or prolactin levels, so monitoring for these is important. Aripiprazole levels may interact with CYP3A4 or CYP2D6 inhibitors or inducers.
Aripiprazole is an atypical antipsychotic used to treat schizophrenia, bipolar mania, major depressive disorder, and irritability associated with autism. It works as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors. Common side effects include headache, insomnia, nausea, and weight gain. It can cause hypotension, extrapyramidal symptoms, and elevated blood glucose or prolactin levels, so monitoring for these is important. Aripiprazole levels may interact with CYP3A4 or CYP2D6 inhibitors or inducers.
Action & Therapeutic Effect: Efficacy of aripiprazole may be
mediated through a combination of partial agonist activity at D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors. Partial dopaminergic agonist property of aripiprazole accounts for antipsychotic treatment of schizophrenic and bipolar individuals.
Uses: Treatment of schizophrenia, bipolar mania, maintenance in
bipolar 1 disorder, adjunct treatment in major depressive disorder, irritability associated with autism.
Unlabeled Uses: Restless leg syndrome, acute psychosis.
Contraindications: Hypersensitivity to aripiprazole; dementia in
elderly; QT prolongation; lactation.
Common adverse effects in italic, life-threatening effects underlined; generic names
in bold; classifications in SMALL CAPS; Canadian drug name; Pr Prototype drug
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Aripiprazole. In Pearson Nurse's Drug Guide 2012 (pp. 111–113). Upper Saddle River, NJ: Prentice Hall. 1 Cautious Use: History of seizures or conditions that lower seizure threshold (e.g., Alzheimer’s dementia); suicidal ideation; depression; brain tumor; dementia; diabetes mellitus; patients with known cardiovascular disease (history of MI or ischemic heart disease, heart failure, or conduction abnormalities), cerebrovascular disease, or conditions that predispose to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications); dysphagia; ethanol intoxication; hyperglycemia, hypothermia; obesity, elderly; pregnancy (category C); children younger than13 y with schizophrenia, children younger than 10 y with bipolar mania, children younger than 6 y with autistic disorder. Safety and efficacy in children with severe depression is not established.
Route & Dosage
Schizophrenia
Adult: PO 10–15 mg once daily, may increase at 2-wk intervals to
max of 30 mg/day if needed
Adolescent/Child (at least 10 y old): PO 2 mg daily, increase to 5 mg
after 2 days, increase to 10 mg after 2 more days. Can increase up to 30 mg.
Bipolar Mania
Adult: PO 15–30 mg once daily
Adolescent/Child (at least 10 y old): PO 2 mg daily, increase to 5 mg
after 2 days, increase to 10 mg after 2 more days. Can increase up to 30 mg.
Agitation Associated with Schizophrenia/Bipolar
Adult: IM 9.75 mg (range: 5.25–15 mg)
Adjunct in Major Depression
Adult: PO 2–5 mg daily
Irritability Associated with Autism
Adolescent/Child (over 6 y old): PO 2 mg daily, increase as needed
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Aripiprazole. In Pearson Nurse's 2 Drug Guide 2012 (pp. 111–113). Upper Saddle River, NJ: Prentice Hall. Pharmacogentic Dosage Adjustment
Reduced CYP2D6 expression (i.e., poor metabolizers): Give 70% of
normal starting dose
Administration
Oral • Remove tablet from blister pack immediately before administration. • Orally disintegrating tablet should be given without water; however, if needed, liquid may be given. Do not split orally disintegrating tablet. • Note that dose should be reduced by 50% with concurrent treatment with ketoconazole, quinidine, fluoxetine, or paroxetine.
Intramuscular • Inject slowly and deeply into a large muscle. • Ensure that drug is not injected intravenously or subcutaneously. • Store at 15°–30° C (59°–86° F).
Adverse Effects (≥1%): Body as a Whole: Headache, asthenia,
etc.) will decrease aripiprazole levels (may need to double aripiprazole dose); use with CYP2D6 or CYP3A4 inhibitors (ketoconazole, quinidine, fluoxetine, paroxetine, etc.) may increase aripiprazole levels (reduce dose by ½); may cause additive sedation with other SEDATIVES (alcohol, tramadol, BARBITURATES, etc.); may enhance effects of ANTIHYPERTENSIVE AGENTS. Herbal: St. John’s wort may decrease aripiprazole levels. Food: High fat meals may delay time to peak plasma levels.
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Aripiprazole. In Pearson Nurse's Drug Guide 2012 (pp. 111–113). Upper Saddle River, NJ: Prentice Hall. 3 Pharmacokinetics: Absorption: 87% bioavailable. Peak: 3–5 h. Metabolism: In liver by CYP3A4 and 2D6. Major metabolite, has some activity. Elimination: 55% in feces, 25% in urine. Half-Life: 75 h (94 h for metabolite); 146 h (poor metabolizers).
Nursing Implications
Assessment & Drug Effects
• Monitor for and report immediately suicidal ideation, especially in children, aldolescents, and young adults. • Monitor cardiovascular status. Assess for and report orthostatic hypotension. Take BP supine then in sitting position. Report systolic drop of greater than 15–20 mm Hg. Patients at increased risk are those who are dehydrated, hypovolemic, or receiving concurrent antihypertensive therapy. • Monitor body temperature in situations likely to elevate core temperature (e.g., exercising strenuously, exposure to extreme heat, receiving drugs with anticholinergic activity, or being subject to dehydration). • Monitor for and report signs of tardive dyskinesia. • Monitor for and immediately report S&S of neuroleptic malignant syndrome (NMS) (see Appendix F). Withhold drug if NMS is suspected. • Lab tests: Periodic Hct and Hgb, and blood glucose. Monitor for elevated CPK and myoglobinuria if NMS is suspected. • Monitor diabetics for loss of glycemic control.
Patient & Family Education
• Report promptly deterioration of mental status or behavior (especially suicidal ideation). • Carefully monitor blood glucose levels if diabetic. • Do not drive or engage in other potentially hazardous activities until reaction to drug is known. • Avoid situations where you are likely to become overheated or dehydrated. • Notify prescriber if you become pregnant or intend to become pregnant while taking this drug.
Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Aripiprazole. In Pearson Nurse's 4 Drug Guide 2012 (pp. 111–113). Upper Saddle River, NJ: Prentice Hall.
