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Mezofy
aripiprazole
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly pts 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 w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber; not approved for depression in peds pts
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 avail. 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: pts <25 yo (depression use)
- caution: elderly pts
- caution: psychosis, dementia-associated
- caution: cerebrovascular dz
- caution: cardiovascular dz
- caution: MI hx
- caution: ischemic heart dz
- caution: heart failure
- caution: hypovolemia
- caution: dehydration
- caution: hypotension
- caution: aspiration pneumonia risk
- caution: seizure hx
- caution: seizure risk
- caution: diabetes mellitus
- caution: diabetes mellitus risk
- caution: environmental temperature, high
- caution: leukopenia
- caution: leukopenia hx, drug-induced
- caution: neutropenia
- caution: neutropenia hx, 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 w/ CYP450 inhibitors if pt 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
- hydrocodone
- iloperidone
- isocarboxazid
- ivosidenib
- kava
- kratom
- lofexidine
- lumateperone
- lurasidone
- metaxalone
- metoclopramide
- midazolam
- olanzapine
- oxybate
- paliperidone
- phenelzine
- pitolisant
- promethazine
- quetiapine
- risperidone
- ropeginterferon alfa-2b
- thalidomide
- tranylcypromine
- trimethobenzamide
- ziprasidone
- zuranolone
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acebutolol
- adagrasib
- alfentanil
- alfuzosin
- aliskiren
- alogliptin
- alprazolam
- amantadine
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- apalutamide
- apomorphine
- apraclonidine ophthalmic
- aprepitant
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- articaine
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- brimonidine ophthalmic
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- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
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- candesartan cilexetil
- cannabis
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- 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
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- conivaptan
- crizotinib
- cyclosporine
- dacomitinib
- danazol
- dapagliflozin
- daridorexant
- darunavir
- denileukin diftitox
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- dihydrocodeine
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- dinutuximab
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- doxepin
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- epoprostenol
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- erythromycin
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- esmolol
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- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- etomidate
- exenatide
- fedratinib
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- flaxseed
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- fluoxetine
- fluphenazine
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- garlic
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- grapefruit
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- lidocaine
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- mepivacaine
- metformin
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- methylene blue injection
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- naxitamab
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- nefazodone
- nelarabine
- nelfinavir
- netupitant
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nirogacestat
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- oliceridine
- olmesartan medoxomil
- opicapone
- opium
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- oxycodone
- oxymorphone
- palopegteriparatide
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- pentazocine
- pentobarbital
- perindopril
- perphenazine
- phenobarbital
- phenoxybenzamine
- phentolamine
- phenytoin
- pindolol
- pioglitazone
- posaconazole
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- pramlintide
- prazosin
- pregabalin
- primidone
- procarbazine
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- propafenone
- propofol
- propranolol
- protriptyline
- quazepam
- quinapril
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- ramipril
- rasagiline
- remifentanil
- remimazolam
- repaglinide
- ribociclib
- rifabutin
- rifampin
- 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
- 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
- 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
- lasmiditan
- 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
- scopolamine
- 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 rxn
- anaphylaxis
- drug rxn w/ eosinophilia and systemic sx
- neuroleptic malignant syndrome
- extrapyramidal sx
- 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 sx
- akathisia
- somnolence
- injection site rxn (IM use)
- insomnia
- hyperglycemia
- anxiety
- fatigue
- nausea
- vomiting
- restlessness
- constipation
- dizziness
- tremor
- fever (peds pts)
- URI
- blurred vision
- sialorrhea (peds pts)
- appetite changes
- xerostomia
- arthralgia
- myalgia
- diarrhea (peds pts)
- impaired body temperature regulation
- compulsive behaviors
Safety/Monitoring .
Monitoring Parameters
fasting glucose at baseline if diabetes risk factors, then periodically; CBC w/ diff frequently during initial tx if pre-existing or hx of leukopenia/neutropenia; weight; sx 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, esp. in 3rd trimester; risk of teratogenicity not expected based on limited human data, though risk of neonatal extrapyramidal and withdrawal sx based on human data w/ antipsychotics
Pregnancy Registry
encourage pts 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: liver; CYP450: 2D6, 3A4 substrate; Info: active metabolite; CYP2D6 poor metabolizers have 60% increased active drug exposure
Excretion: 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
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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