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Mezofy
aripiprazole
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly patients on antipsychotic tx for dementia-related psychosis; most deaths due to cardiovascular or infectious events
Suicidality
incr. suicidality risk in children, adolescents, and young adults with major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in patients >24 yo, and risk decr. in patients 65 yo and older; depression and certain other psychiatric disorders themselves associated with incr. suicide risk; observe all patients for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication with prescriber; not approved for depression in peds patients
Adult Dosing .
Dosage forms: STRIP: 5 mg, 10 mg, 15 mg
schizophrenia
- [10-15 mg PO qd]
- Start: 10-15 mg PO qd; may incr. dose q2wk; Max: 30 mg/day; Info: doses >15 mg/day rarely more effective; decr. dose 50% in CYP2D6 poor metabolizers; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew/swallow strip; may use other oral aripiprazole products for dose adjustments
renal dosing
- [see below]
- CrCl >15: no adjustment; CrCl <15: not defined
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: STRIP: 5 mg, 10 mg, 15 mg
schizophrenia
- [13-17 yo]
- Dose: 10 mg PO qd; Start: 2 mg PO qd x2 days, then 5 mg PO qd x2 days, then incr. dose in 5 mg increments; Max: 30 mg/day; Info: doses >10 mg/day rarely more effective; decr. dose 50% in CYP2D6 poor metabolizers; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew/swallow strip; 2 mg strip form not available for this brand, may use other oral aripiprazole products for start dose and dose adjustments
renal dosing
- [see below]
- CrCl >15: no adjustment; CrCl <15: not defined
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: CYP2D6 poor metabolizers
- caution: patients <25 yo (depression use)
- caution: elderly patients
- caution: psychosis, dementia-associated
- caution: cerebrovascular disease
- caution: cardiovascular disease
- caution: MI history
- caution: ischemic heart disease
- caution: heart failure
- caution: hypovolemia
- caution: dehydration
- caution: hypotension
- caution: aspiration pneumonia risk
- caution: seizure history
- caution: seizure risk
- caution: diabetes mellitus
- caution: diabetes mellitus risk
- caution: environmental temperature, high
- caution: leukopenia
- caution: leukopenia history, drug-induced
- caution: neutropenia
- caution: neutropenia history, drug-induced
- caution: PKU (phenylalanine-containing form)
Drug Interactions .
Overview
aripiprazole oral
atypical antipsychotic
- CYP2D6 substrate
- CYP3A4 substrate
- CNS depression
- decreases central histamine effects
- extrapyramidal effects
- hyperglycemic effects
- hyperthermia
- hypotensive effects
- lowers seizure threshold
- drug interactions apply only to oral aripiprazole forms; see other aripiprazole products for potentially relevant interactions
- aripiprazole is a substrate of CYP2D6 and CYP3A4; drug interaction guidance may vary with CYP450 inhibitors if patient is CYP2D6 poor metabolizer (PM)
Avoid/Use Alternative
- aldesleukin
- amifampridine
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- brexpiprazole
- butalbital
- cariprazine
- clonidine
- clozapine
- codeine
- doxylamine
- ethanol (alcoholic beverage)
- ethanol injection
- haloperidol
- hydrocodone
- iloperidone
- isocarboxazid
- ivosidenib
- kava
- kratom
- lofexidine
- lumateperone
- lurasidone
- metaxalone
- metoclopramide
- midazolam
- milsaperidone
- olanzapine
- oxybate
- paliperidone
- phenelzine
- pitolisant
- promethazine
- quetiapine
- risperidone
- ropeginterferon alfa-2b
- scopolamine
- thalidomide
- tradipitant
- tranylcypromine
- trimethobenzamide
- ziprasidone
- zuranolone
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acebutolol
- adagrasib
- alfentanil
- alfuzosin
- aliskiren
- alogliptin
- alprazolam
- alprostadil intracavernous
- amantadine
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- apalutamide
- apomorphine
- apraclonidine ophthalmic
- aprepitant
- aprocitentan
- articaine
- atazanavir
- atenolol
- avacopan
- avanafil
- azilsartan medoxomil
- baclofen intrathecal
- benazepril
- berberine
- berotralstat
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bexagliflozin
- bisoprolol
- bortezomib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
- cabergoline
- canagliflozin
- candesartan cilexetil
- cannabis
- capivasertib
- captopril
- carbamazepine
- carteolol ophthalmic
- carvedilol
- ceritinib
- chloramphenicol
- chlordiazepoxide
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- cinacalcet
- ciprofloxacin
- clarithromycin
- clevidipine
- clobazam
- clofarabine
- clofazimine
- clomipramine
- clonazepam
- clorazepate
- cobicistat
- coenzyme Q-10
- colesevelam
- conivaptan
- crizotinib
- cyclosporine
- dacomitinib
- danazol
- dapagliflozin
- daridorexant
- darunavir
- denileukin diftitox
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- dihydrocodeine
- diltiazem
- dinutuximab
- dipyridamole
- doxazosin
- doxepin
- dronabinol
- dronedarone
- droperidol
- dulaglutide
- duloxetine
- duvelisib
- eliglustat
- empagliflozin
- enalapril
- enalaprilat
- encorafenib
- entacapone
- entrectinib
- enzalutamide
- eplerenone
- epoprostenol
- ertugliflozin
- erythromycin
- esketamine
- esmolol
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- etomidate
- etripamil nasal
- exenatide
- fedratinib
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- flaxseed
- flibanserin
- fluconazole
- fluoxetine
- fluphenazine
- flurazepam
- fosamprenavir
- fosinopril
- foslevodopa
- fosphenytoin
- furosemide
- gabapentin
- gabapentin enacarbil
- garlic
- gilteritinib
- givosiran
- glimepiride
- glipizide
- glyburide
- grapefruit
- guanfacine
- hydralazine
- hydrochlorothiazide
- hydromorphone
- hydroxyzine
- idelalisib
- ifosfamide
- iloprost
- imatinib
- imipramine
- indapamide
- insulin
- iohexol
- iopamidol
- irbesartan
- iron sucrose
- isavuconazonium
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- itraconazole
- ketamine
- ketoconazole
- labetalol
- landiolol
- lefamulin
- lemborexant
- lenacapavir
- letermovir
- levobunolol ophthalmic
- levodopa
- levoketoconazole
- levorphanol
- lidocaine
- linagliptin
- liraglutide
- lisinopril
- lithium
- lixisenatide
- lonafarnib
- lopinavir/ritonavir
- lorazepam
- losartan
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- magnesium sulfate
- maraviroc
- mavorixafor
- meperidine
- mepivacaine
- metformin
- methadone
- methohexital
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- mifepristone
- miglitol
- milrinone
- minoxidil
- mirabegron
- mirtazapine
- mitotane
- moexipril
- molindone
- morphine
- nadolol
- nalbuphine
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- nefazodone
- nelarabine
- nelfinavir
- netupitant
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nirogacestat
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- obinutuzumab
- oliceridine
- olmesartan medoxomil
- opicapone
- opium
- oxazepam
- oxybutynin
- oxycodone
- oxymorphone
- palopegteriparatide
- paroxetine
- pentamidine
- pentazocine
- pentobarbital
- perindopril
- perphenazine
- phenobarbital
- phenoxybenzamine
- phentolamine
- phenytoin
- pindolol
- pioglitazone
- posaconazole
- pramipexole
- pramlintide
- prazosin
- pregabalin
- primidone
- procarbazine
- prochlorperazine
- propafenone
- propofol
- propranolol
- protriptyline
- quazepam
- quinapril
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- ramipril
- rasagiline
- remifentanil
- remimazolam
- repaglinide
- ribociclib
- rifabutin
- rifampin
- rilzabrutinib
- riociguat
- ritonavir
- rolapitant
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- sacubitril
- safinamide
- saxagliptin
- selegiline
- selegiline transdermal
- semaglutide
- sevoflurane
- sildenafil
- silodosin
- sitagliptin
- sodium ferric gluconate complex
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- St. John's wort
- sufentanil
- suvorexant
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- temazepam
- terazosin
- terbinafine
- thioridazine
- thiothixene
- timolol
- timolol ophthalmic
- tipranavir
- tirzepatide
- tizanidine
- tolcapone
- torsemide
- tramadol
- trandolapril
- trazodone
- treprostinil
- triamterene
- triazolam
- trifluoperazine
- trimipramine
- tucatinib
- valsartan
- vardenafil
- verapamil
- voriconazole
- vosoritide
- yohimbe
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- acetazolamide
- aclidinium inhaled
- allopurinol
- almotriptan
- atropine
- baclofen
- belladonna alkaloids
- benztropine
- bosentan
- botulinum toxin
- brivaracetam
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- carbinoxamine
- carisoprodol
- cenobamate
- cetirizine
- chamomile, German
- chlophedianol
- chlorambucil
- chlorcyclizine
- chloroquine
- chlorpheniramine
- chlorzoxazone
- citalopram
- clemastine
- clidinium
- cyclobenzaprine
- cyproheptadine
- dabrafenib
- dantrolene
- darifenacin
- desvenlafaxine
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dichlorphenamide
- dicyclomine
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- disopyramide
- domperidone
- doxepin topical
- efavirenz
- eletriptan
- elinzanetant
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- etravirine
- felbamate
- fenfluramine
- fesoterodine
- fexinidazole
- flavoxate
- fluvoxamine
- frovatriptan
- galantamine
- ganaxolone
- ginseng, Asian
- glofitamab
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- homatropine
- hydroxychloroquine
- hyoscyamine
- ipratropium inhaled
- lacosamide
- lamotrigine
- levetiracetam
- levocetirizine
- levomilnacipran
- linvoseltamab
- lorlatinib
- magnesium citrate
- mavacamten
- meclizine
- melatonin
- meprobamate
- methocarbamol
- methscopolamine
- methsuximide
- metyrapone
- metyrosine
- milnacipran
- mitapivat
- modafinil
- mosunetuzumab
- mycophenolate mofetil
- nafcillin
- naltrexone
- naratriptan
- orphenadrine
- oxcarbazepine
- pacritinib
- passion flower
- perampanel
- pexidartinib
- pheniramine
- pimozide
- polyethylene glycol
- polyethylene glycol/electrolytes
- pyrilamine
- ramelteon
- repotrectinib
- revefenacin inhaled
- rifapentine
- rivastigmine
- rizatriptan
- rufinamide
- selinexor
- sertraline
- sodium picosulfate
- sofpironium topical
- solifenacin
- sotorasib
- stiripentol
- sulfate bowel prep
- sumatriptan
- tasimelteon
- tetrabenazine
- thiotepa
- tiagabine
- tiotropium inhaled
- tolterodine
- topiramate
- treosulfan
- trihexyphenidyl
- triprolidine
- trospium
- umeclidinium inhaled
- valbenazine
- valerian
- valproic acid
- venlafaxine
- vigabatrin
- vilazodone
- viloxazine
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- drug reaction with eosinophilia and systemic symptoms
- neuroleptic malignant syndrome
- extrapyramidal symptoms
- tardive dyskinesia
- dystonia
- stroke
- TIA
- syncope
- hypotension, orthostatic
- seizures
- hyperglycemia
- diabetes mellitus
- dysphagia, severe
- aspiration
- hyperthermia
- hypothermia
- pancreatitis
- blood dyscrasia
- leukopenia
- neutropenia
- agranulocytosis
- rhabdomyolysis
- suicidality
- depression exacerbation
Common Reactions
- headache
- dyslipidemia
- weight gain
- extrapyramidal symptoms
- akathisia
- somnolence
- injection site reaction (IM use)
- insomnia
- hyperglycemia
- anxiety
- fatigue
- nausea
- vomiting
- restlessness
- constipation
- dizziness
- tremor
- fever (peds patients)
- URI
- blurred vision
- sialorrhea (peds patients)
- appetite changes
- xerostomia
- arthralgia
- myalgia
- diarrhea (peds patients)
- impaired body temperature regulation
- compulsive behaviors
Safety/Monitoring .
Monitoring Parameters
fasting glucose at baseline if diabetes risk factors, then periodically; CBC with diff frequently during initial tx if pre-existing or history of leukopenia/neutropenia; weight; symptoms of suicidality, clinical worsening, and/or unusual behavior changes, especially during initial tx or after dose changes; consider orthostatic vital signs if hypotension risk
Look/Sound-Alike Drug Names
ARIPiprazole confused with: lansoprazole; omeprazole; RABEprazole
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially in 3rd trimester; risk of teratogenicity not expected based on limited human data, though risk of neonatal extrapyramidal and withdrawal symptoms based on human data with antipsychotics
Pregnancy Registry
encourage patients to enroll in National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or www.womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding, monitor infant for dehydration and poor wt. gain; possible risk of infant harm based on limited human data; decr. milk production based on human data and decr. prolactin levels
Pharmacology .
Metabolism: for aripiprazole: liver; CYP450: 2D6, 3A4 substrate; Info: active metabolite; CYP2D6 poor metabolizers have 60% increased active drug exposure
Excretion: for aripiprazole: feces 55% (18% unchanged), urine 25% (<1% unchanged); Half-life: 75h (IR form, CYP2D6 extensive metabolizers), 146h (IR form, CYP2D6 poor metabolizers), 29.9-46.5 days (1-mo IM form), 21 days (bimonthly IM form)
Subclass: Antipsychotics, 2nd generation
Mechanism of Action
for aripiprazole: exact mechanism of action unknown; partially agonizes dopamine D2 and serotonin 5-HT1A receptors, antagonizes serotonin 5-HT2A receptors
Formulary .
No Formulary Selected
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