Home Drug Guide Aripiprazole

Drug Guide

Generic Name

Aripiprazole

Brand Names Abilify, Abilify Maintena Kit, Abilify Mycite Kit, Mezofy, Opipza, Abilify Asimtufii

Classification

Therapeutic: Antipsychotic

Pharmacological: Partial dopamine agonist, dopamine D2/D3 receptor antagonist

FDA Approved Indications

  • Schizophrenia in adults and adolescents
  • Bipolar I disorder in adults and pediatric patients aged 10 and older
  • Major depressive disorder (adjunctive)
  • Irritability associated with autism spectrum disorder in children aged 6 and older
  • Tourettes disorder (short-term use)

Mechanism of Action

Aripiprazole acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A receptors. This modulation stabilizes neurotransmitter activity related to psychosis and mood disorders.

Dosage and Administration

Adult: Dosage varies by condition. For schizophrenia, typically starting at 10-15 mg once daily, titrated as needed. For bipolar disorder, usual starting dose is 15 mg daily.

Pediatric: Schizophrenia: 10-30 mg once daily; Bipolar disorder: 10-30 mg once daily, based on the specific indication and age.

Geriatric: Usually starting at the lower end of the dosing range, with careful monitoring.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Start at lower doses; monitor closely.

Pharmacokinetics

Absorption: Well absorbed orally, with peak plasma concentrations within 3-5 hours.

Distribution: Highly protein bound (~99%), volume of distribution approximately 12 L/kg.

Metabolism: Extensively metabolized in the liver via CYP2D6 and CYP3A4 enzymes.

Excretion: Primarily excreted in feces (about 60%) and urine (about 25%).

Half Life: Approximately 75 hours (range 47-136 hours).

Contraindications

  • None specific, but use cautiously in patients with hypersensitivity.

Precautions

  • Use with caution in elderly patients with dementia-related psychosis due to increased risk of mortality.
  • Monitor for metabolic side effects, including weight gain, hyperglycemia, and dyslipidemia.
  • Assess for suicidality, especially in pediatric and young adult patients.

Adverse Reactions - Common

  • Akathisia (frequent)
  • Weight gain (common)
  • Insomnia (common)
  • Nausea (common)

Adverse Reactions - Serious

  • Extrapyramidal symptoms (uncommon)
  • Neuroleptic malignant syndrome (rare)
  • QT prolongation (rare)
  • Seizures (rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors or inducers (e.g., ketoconazole, rifampin) may alter aripiprazole levels.
  • Other CNS depressants may enhance sedative effects.

Drug-Food Interactions

  • Avoid grapefruit juice as it may increase plasma concentrations.

Drug-Herb Interactions

  • St. John’s Wort may reduce aripiprazole levels.

Nursing Implications

Assessment: Monitor mental status, mood, and behavior; check baseline weight, glucose, lipids. Watch for signs of movement disorders and metabolic changes.

Diagnoses:

  • Risk for weight gain related to medication side effects.
  • Risk for extrapyramidal symptoms.

Implementation: Administer with or without food. Educate about potential side effects, importance of adherence, and regular lab monitoring.

Evaluation: Assess effectiveness in managing symptoms; monitor for adverse reactions; evaluate metabolic parameters periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any concerning side effects such as movement changes or severe sedation.
  • Maintain regular follow-up appointments for monitoring.
  • Inform about potential metabolic side effects and lifestyle modifications needed.

Special Considerations

Black Box Warnings:

  • Increased mortality in elderly patients with dementia-related psychosis.
  • Suicidality risk in children, adolescents, and young adults.

Genetic Factors: CYP2D6 poor metabolizers may have higher plasma levels; consider dose adjustment.

Lab Test Interference: May affect blood glucose and lipid tests.

Overdose Management

Signs/Symptoms: Drowsiness, dizziness, agitation, tachycardia, vomiting, hallucinations, seizures.

Treatment: Supportive care, activated charcoal if ingestion is recent, and symptomatic treatment. No specific antidote.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F). Keep container tightly closed.

Stability: Stable under recommended storage conditions for the duration of the labeled shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.