Home Drug Guide Aripiprazole Lauroxil

Drug Guide

Generic Name

Aripiprazole Lauroxil

Brand Names Aristada, Aristada Initio Kit

Classification

Therapeutic: Antipsychotic, Long-acting injectable

Pharmacological: Atypical antipsychotic, D2 dopamine receptor partial agonist

FDA Approved Indications

  • Schizophrenia in adults
  • Maintenance treatment of schizophrenia

Mechanism of Action

Aripiprazole Lauroxil is a prodrug of aripiprazole, which acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, and an antagonist at 5-HT2A receptors, modulating neurotransmission involved in psychosis.

Dosage and Administration

Adult: Initial dose of 441 mg administered as a single injection, adjustable based on response, then maintenance doses typically ranging from 441 mg monthly. For Aristada Initio, 675 mg intramuscularly once, followed by compatible doses.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; no specific dose adjustments provided.

Renal Impairment: Adjust dosage based on clinical response; specific guidelines not established.

Hepatic Impairment: No specific adjustments recommended but monitor for adverse effects.

Pharmacokinetics

Absorption: Well absorbed after IM injection.

Distribution: Sparse protein binding (~99%).

Metabolism: Extensively metabolized by CYP3A4 and CYP2D6 enzymes to active metabolites.

Excretion: Primarily via feces (~54%) and urine (~24%).

Half Life: Approximately 54 days due to depot formulation.

Contraindications

  • Hypersensitivity to aripiprazole or excipients.

Precautions

  • Risk of suicidal thoughts, cardiovascular disease, neuroleptic malignant syndrome, impulse control problems, orthostatic hypotension, elderly patients with dementia-related psychosis are at increased risk of death.

Adverse Reactions - Common

  • Injection site pain (Common)
  • Akathisia (Common)
  • Somnolence (Common)
  • Dizziness (Common)

Adverse Reactions - Serious

  • Neuroleptic malignant syndrome (Uncommon)
  • Extrapyramidal symptoms (Uncommon)
  • QT prolongation (Uncommon)
  • Suicidal thoughts (Uncommon)

Drug-Drug Interactions

  • CYP3A4 inhibitors or inducers (e.g., ketoconazole, rifampin) which can alter aripiprazole levels.

Drug-Food Interactions

  • Avoid alcohol and CNS depressants.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for effectiveness, adverse effects, injection site reactions, mental status, and metabolic parameters.

Diagnoses:

  • Risk for falls
  • Imbalanced nutrition: less than body requirements
  • Risk for metabolic syndrome

Implementation: Administer IM injections as ordered, observe for adverse reactions, counsel about potential side effects.

Evaluation: Assess for symptom improvement, side effects, and adherence.

Patient/Family Teaching

  • Instruct on importance of adherence to injection schedule.
  • Report any abnormal movements, severe dizziness, or allergic reactions.
  • Avoid alcohol and CNS depressants.
  • Be aware of signs of worsening depression or suicidal thoughts.

Special Considerations

Black Box Warnings:

  • Increased risk of death in elderly patients with dementia-related psychosis.
  • Suicide-related events in young adults.

Genetic Factors: CYP2D6 metabolizer status may affect drug levels.

Lab Test Interference: May cause false-positive results for catecholamine metabolites.

Overdose Management

Signs/Symptoms: Dizziness, drowsiness, agitation, seizure, coma.

Treatment: Supportive care; no specific antidote. Consider activated charcoal if ingestion occurred recently; provide supportive measures and monitor vital signs; use benzodiazepines for agitation if needed.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F). Keep in original container until use.

Stability: Stable under recommended storage conditions until expiration date.

🛡️ 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.