- Last edited on January 21, 2024
Aripiprazole (Abilify)
Primer
Aripiprazole (Trade name: Abilify) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar disorder. It is also used as an adjunctive medication in major depressive disorder.
Pharmacokinetics
See also article: Introduction to Pharmacology
Pharmacokinetics of Aripiprazole
Absorption | Peak plasma concentrations occurring within 3 to 5 hours. Oral bioavailability is 87%. |
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Distribution | 4.9 L/kg (99% bound to serum proteins, primarily albumin) |
Metabolism | Hepatic |
Elimination | Hepatic (minimal renal) |
Half-life | 75 to 94 hours (long half life!) |
See also article: Cytochrome (CYP) P450 Metabolism
Aripiprazole: Cytochrome P450 Metabolism
Substrate of (Metabolized by) | 2D6, 3A4 |
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Induces | - |
Inhibits | - |
Pharmacodynamics
Mechanism of Action
Toxicity
Indications
- Schizophrenia (childhood, adolescent, and adult)
- Bipolar I Disorder, maintenance monotherapy
Dosing
Dosing for Aripiprazole
Starting | 2 mg PO qAM |
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Titration | 2-5 mg increments every 2-3 weeks |
Maximum | 30 mg (though 20 mg is a typical dose) |
Taper |
Formulations
- Aripiprazole comes in oral and intramuscular formulations.
Abilify Maintena (1-month Long-Acting Injectable)
- Abilify Maintena is an extended-release (also known as long-acting) injectable suspension available in 400 mg or 300 mg formulations, given once every 4 weeks.
- Requires a period of 2 weeks of oral dosing (“oral bridge”) with oral aripiprazole
- Can be given via deep intramuscular (IM) deltoid or gluteal injection
Monitoring
Contraindications
Absolute
Relative
Drug-Drug Interactions
Side Effects
- There does not appear to be a bleeding risk although there are other possible haematological side effects, i.e. leucopenia, neutropenia or thrombocytopenia (incidence; 0.1% to 1%). CBC should be monitored.
- Urinary retention has been rarely reported.[2]
Adverse Events
Impusle-Control Disorders
- Since aripiprazole is a partial dopamine agonist it is possible that the increased dopaminergic activity may induce impulsivity (similar to what is seen in patients on dopamine agonists like L-dopa).
- Rare but serious impulse-control problems, such as pathological gambling, compulsive eating, compulsive shopping, and compulsive sexual behavior have been reported in patients treated with aripiprazole.[3]
Clinical Pearls
Special Populations
Geriatric
See main article: Geriatric Pharmacology
Pediatric
See main article: Pediatric Pharmacology
Obstetric and Fetal
See main article: Obstetric and Fetal Pharmacology
Medically Ill
See main article: Psychotropic Dosing in the Medically Ill
Resources
References
1)
Kotlyar, M., Brauer, L. H., Tracy, T. S., Hatsukami, D. K., Harris, J., Bronars, C. A., & Adson, D. E. (2005). Inhibition of CYP2D6 activity by bupropion. Journal of clinical psychopharmacology, 25(3), 226-229.
2)
Hsu, W. Y., Chang, T. G., & Chiu, N. Y. (2013). Aripiprazole associated urine retention in a male schizophrenia patient. General hospital psychiatry, 35(6), 680-e11.
3)
Grall-Bronnec, M., Sauvaget, A., Perrouin, F., Leboucher, J., Etcheverrigaray, F., Challet-Bouju, G., ... & Victorri-Vigneau, C. (2016). Pathological gambling associated with aripiprazole or dopamine replacement therapy: do patients share the same features? A review. Journal of clinical psychopharmacology, 36(1), 63.