Pharmacy Author: Emmanuel Saltiel,
Pharm. D.
Medical Editor: Jay Marks, M.D.
GENERIC NAME: aripiprazole
BRAND NAME: Abilify
DRUG CLASS AND MECHANISM:
Aripiprazole is an anti-psychotic drug for treating psychoses. Like other
anti-psychotic drugs, the mechanism of action of aripiprazole is unknown.
Moreover, like other anti-psychotics, it blocks several receptors on the nerves
of the brain for several neurotransmitters (chemicals that nerves use to
communicate with each other). It is thought that its beneficial effect is due to
its effects on dopamine and serotonin receptors. Its effects on these receptors
are complex, involving stimulation of the receptors but to a lesser degree than
the naturally-occurring neurotransmitters (a process called partial agonism).
The FDA approved aripiprazole in November 2002.
PRESCRIPTION: Yes.
GENERIC AVAILABLE: No.
PREPARATIONS: Tablets: 10, 15, 20, and 30 mg. Oral solution: 1 mg/mL
STORAGE: Tablets should be stored at room temperature, 15-30 C (59-86 F).
PRESCRIBED FOR: Aripiprazole
is used to treat schizophrenia,
bipolar mania and mixed manic/depressisve episodes (as sole or adjunctive therapy) and as adjunctive (add-on) therapy for
major depressive disorder.
DOSING: Aripiprazole usually is taken once a day. The usual starting dose is 10 or 15 mg once daily. The dose may be increased over time to achieve the desired effect. Aripiprazole can be taken with or without food.
DRUG INTERACTIONS: Carbamazepine (Tegretol) can markedly decrease the amount of aripiprazole in the body by increasing the rate at which the body's enzymes (particularly the liver enzyme, CYP3A4) degrade it. The manufacturer recommends that patients on aripiprazole who are started on carbamazepine double their dose of aripiprazole, under their doctor's supervision. Other drugs that can promote the activity of CYP3A4 and decrease the body's levels of aripiprazole are phenytoin (Dilantin), rifampin
(Rifadin, Rimactane,
Rifadin,
Rifater,
Rifamate), and phenobarbital.
Ketoconazole (Nizoral) can increase the amount of aripiprazole in the body by blocking CYP3A4. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during ketoconazole therapy. Many other drugs also are known to block CYP3A4 and potentially could increase the levels of aripiprazole, but their actual effects on aripiprazole levels have not been studied. Such drugs include: itraconazole (Sporanox), fluconazole (Diflucan),
voriconazole (Vfend), cimetidine (Tagamet), verapamil (Calan; Isoptin); diltiazem (Cardizem; Dilacor), erythromycin, clarithromycin (Biaxin), nefazodone (Serzone), ritonavir (Norvir), saquinavir (Invirase), nelfinavir (Viracept), indinavir (Crixivan), and grapefruit juice.
Quinidine (Quinaglute,
Quinidex) inhibits another liver enzyme known as CYP2D6 that also breaks down aripiprazole and can increase the amount of aripiprazole in the body. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during quinidine therapy. Other medicines that block CYP2D6 include fluoxetine (Prozac) and paroxetine (Paxil).
Alpha-1 receptor blockers [doxazosin (Cardura),
prazosin (Minipress), terazosin (Hytrin), used for control of blood pressure and prostatic enlargement, may increase the chance of hypotension (unusually low blood pressure).
PREGNANCY: Aripiprazole has not been studied in
pregnant women. However, some unwanted effects have been reported in animal studies. The physician may chose to use aripiprazole if he
or she feels that it its benefits outweigh this potential concern.
NURSING MOTHERS: It is not known if aripiprazole is excreted in
breast milk; however, since most medicines are excreted in breast milk, it is recommended that women receiving aripiprazole should not breast feed.
SIDE EFFECTS: Some of the most common side effects associated with aripiprazole are anxiety, blurred vision, constipation, cough, headache,
insomnia, lightheadedness, nausea, rash, restlessness, runny nose, sleepiness, tremors,
vomiting, weakness, and weight gain. As with other anti-psychotics, long-term use of aripiprazole may lead to a potentially irreversible condition called tardive dyskinesia (involuntary movements of the jaw, lips, and tongue). A potentially fatal complex referred to as neuroleptic malignant syndrome has been reported with anti-psychotic drugs, including aripiprazole. Patients who develop this syndrome may have high fevers, muscle rigidity, altered mental status, irregular pulse or blood pressure, rapid heart rate, excessive sweating, and heart arrhythmias.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Depression - Read about depression causes, symptoms, diagnosis, treatment and types, including manic depression (bipolar disorder), postpartum depression and clinical depression.
- Schizophrenia - Get information on schizophrenia symptoms (delusions, hallucinations), causes (genetics), diagnosis, treatment of schizophrenics (antipsychotic drugs) and types (paranoid).
- Bipolar Disorder (Mania) - Read about bipolar disorder (BD or manic-depressive illness), a brain disorder that causes dramatic mood swings (highs and lows) and affects a person's energy levels and ability to function. These highs and lows are episodes of mania and depression. The mania symptoms of manic depression include increased energy, extreme irritability, spending sprees, and increased sex drive. Depression symptoms include feelings of hopelessness and worthlessness, decreased energy, thoughts of death or suicide, and chronic pain. Long-term preventive treatment combining medication and psychosocial treatment is recommended.
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