Aripiprazole (Abilify)

Second generation antipsychotic (Low dose: dopamine-D3 serotonin partial agonist and antagonist; Upper dose: dopamine, serotonin receptor partial agonist (D2, 5-HT1A) receptor antagonist (5-HT2A))

Dosing

Depression augmentation (2-10 mg/d, usually 5 mg/d), Mania/mixed (10-30 mg/d), Schizophrenia (10-30 mg/d), OCD (but may also cause OCD, 5-10 mg/d).

INTERACTIONS: Metabolized by CYP3A4 and CYP2D6. Raise by 2-3x if using with carbamazepine. Abilify can (rarely) cause pathologic gambling (similar to mirapex, a dopamine D3 agonist effect).

Management

Main side effect is akathisia (start low, go slow). Half life long so can give every other day. Low metabolic risks but 10% chance weight gain. Some find it activating (take in morning) but 10% have fatigue on it. Aripiprazole treats hyperprolactinemia on other antipsychotics and augments clozapine.

Be careful when switching to aripiprazole in schizophrenia as sometimes there is a rebound psychosis because of the different mechanisms (aripiprazole is partial agonist at D2, while others block it).

TOLERABILITY: Weight gain, sedation, akathisia, EPS (dystonia, stiffness), anticholinergic.

RISKS: Tardive dyskinesia (25% over 10 years, higher in elderly), metabolic, orthostasis (falls), QTc prolongation, temperature imbalance in elderly, NMS (muscle rigidity, fever, tachycardia).

No risk of prolactinemia.

EMR Text