II. Class

  1. Atypical Antipsychotic (Second Generation agent)

III. Indications

  1. Schizophrenia
  2. Bipolar Disorder
  3. Major Depression (adjunct in refractory cases)

IV. Advantages

  1. Lower weight gain than other second generation Antipsychotic agents
  2. Lower diabetes risk than other second generation Antipsychotic agents

V. Precautions

  1. Despite generic in 2015, price still approaches $800 per month
  2. Primary role remains as an Antipsychotic for Schizophrenia and Bipolar Disorder
    1. Only consider adjunctively in severe Major Depression refractory to other measures

VI. Drug Interactions

  1. Increase Antipsychotic levels (toxicity risk): Monitor for Aripiprazole toxicity
    1. Clarithromycin
    2. Erythromycin
    3. Grapefruit juice
  2. Increase Antipsychotic levels (toxicity risk): Lower Aripiprazole dose to half
    1. Itraconazole
    2. Ketoconazole
    3. Quinidine
  3. Decrease Antipsychotic levels (lower efficacy)
    1. Barbiturates
    2. Carbamazepine
    3. Phenytoin

VII. Efficacy: Depression

  1. Depression remits in 25% of patients by 6 weeks (effects may be seen by 1 week)

VIII. Adverse Effects

  1. Headache
  2. Restlessness or agitation
  3. Insomnia
  4. Anxiety
  5. Extrapyramidal Side Effects in up to 17% of patients
  6. Nausea
  7. Constipation
  8. Fatigue or Sedation
  9. Impulse control behaviors (rare)
    1. Behaviors seen with other Dopamine Agonists (e.g. Compulsive Gambling, hypersexuality, shopping, eating)
    2. Moore (2014) JAMA Intern Med 174(12):1930-3 [PubMed]

IX. Monitoring

X. Dosing: Schizophrenia or Bipolar Disorder

  1. Starting dose: 10-15 mg once daily
  2. Maximum dose: 30 mg/day

XI. Dosing: Major Depression (in refractory and atypical cases)

  1. Starting dose: 2-5 mg/day
  2. Maximum dose: 15 mg/day (up to 30 mg/day has been used)

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Cost: Medications

aripiprazole (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ARIPIPRAZOLE 1 MG/ML SOLUTION Generic $4.45 per ml
ARIPIPRAZOLE 10 MG TABLET Generic $4.20 each
ARIPIPRAZOLE 15 MG TABLET Generic $3.89 each
ARIPIPRAZOLE 2 MG TABLET Generic $3.84 each
ARIPIPRAZOLE 20 MG TABLET Generic $5.65 each
ARIPIPRAZOLE 30 MG TABLET Generic $5.53 each
ARIPIPRAZOLE 5 MG TABLET Generic $3.90 each
abilify (on 2/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ABILIFY 10 MG TABLET Generic $4.20 each
ABILIFY 15 MG TABLET Generic $3.89 each
ABILIFY 2 MG TABLET Generic $3.84 each
ABILIFY 20 MG TABLET Generic $5.65 each
ABILIFY 30 MG TABLET Generic $5.53 each
ABILIFY 5 MG TABLET Generic $3.90 each
ABILIFY MAINTENA ER 300 MG SYR $1,289.98 each
ABILIFY MAINTENA ER 300 MG VL $1,295.05 each
ABILIFY MAINTENA ER 400 MG SYR $1,748.96 each
ABILIFY MAINTENA ER 400 MG VL $1,750.96 each

Ontology: aripiprazole (C0299792)

Definition (NCI) A quinoline derivate and atypical anti-psychotic agent. Aripiprazole has partial agonistic activity at dopamine D2 receptors and serotonin 5-HT1A receptors, as well as potent antagonistic activity on serotonin 5-HT2A receptors. This drug stabilizes dopamine and serotonin activity in the limbic and cortical system. Aripiprazole is used in managing symptoms of schizophrenia and of acute manic and mixed episodes associated with bipolar I disorders.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C094645
SnomedCT 406785006, 406784005
LNC LP34967-7, MTHU017703
English 7-(4-(4-(2,3-dichlorophenyl)-1-piperazinyl)butyloxy)-3,4-dihydro-2(1H)-quinolinone, 2(1H)-Quinolinone, 7-(4-(4-(2,3-Dichlorophenyl)-1-piperazinyl)butoxy)-3,4-dihydro-, aripiprazole, aripiprazole (medication), ARIPIPRAZOLE, aripiprazole [Chemical/Ingredient], ARIPiprazole, Aripiprazole (product), Aripiprazole (substance), Aripiprazole
Spanish aripiprazol (producto), aripiprazol (sustancia), aripiprazol

Ontology: Abilify (C1170019)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C094645
English Abilify, abilify, Bristol-Myers Squibb brand of aripiprazole, Otsuka brand of aripiprazole