aripiprazole: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
aripiprazole: clinical details
Prescribing considerations
- Confirm the licensed indication and age group for the chosen formulation.
- The prolonged-release injection is for maintenance in adults stabilised on oral aripiprazole, not immediate control of acute agitation.
- Assess suicide, cardiovascular, thromboembolic, diabetes, seizure, aspiration, falls and impulse-control risks.
- Ask patients and carers about new gambling, spending, eating or sexual urges.
Contraindications and cautions
- Hypersensitivity to aripiprazole or a formulation excipient.
- Aripiprazole is not indicated for dementia-related psychosis; increased mortality and cerebrovascular events have been observed.
- Use caution with cardiovascular disease, hypotension, family history of QT prolongation, seizures, diabetes risk, venous-thromboembolism risk and aspiration risk.
Monitoring
- Monitor clinical response, suicidality and behavioural change.
- Monitor weight and metabolic health; regularly check glucose control in people with diabetes or risk factors.
- Assess akathisia, parkinsonism, dystonia and tardive dyskinesia.
- Review impulse control with the patient and, where appropriate, family or carers.
- With short-acting intramuscular treatment, monitor blood pressure, pulse, respiratory rate and consciousness.
- With prolonged-release injections, assess injection sites and review missed appointments promptly.
Clinical pharmacology
A partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2A receptors. It is extensively metabolised through CYP2D6 and CYP3A4 to an active metabolite, is highly protein bound and has prolonged elimination.
Formulation and product differences
- Standard tablets are swallowed.
- Elozar orodispersible tablets disperse on the tongue or in water; they are fragile and contain aspartame and lactose.
- Oral solutions require an appropriate calibrated measuring device; excipients differ between products.
- Prolonged-release intramuscular preparations are administered into the deltoid or gluteal muscle by a healthcare professional for maintenance treatment.
- Immediate-release intramuscular solution is ready to use for short-term control of agitation and must not be given intravenously or subcutaneously.
aripiprazole preparations and strengths
Dispersible tablet
Route: Oral
Strengths: 10 mg, 15 mg, 30 mg
Oral solution
Route: Oral
Strengths: 1 mg/mL
aripiprazole interactions
Check prescribed, over-the-counter and herbal products before combining them with aripiprazole.
Fluoxetine, paroxetine or quinidine
Can raise aripiprazole exposure and adverse effects.
Ketoconazole, itraconazole or strong HIV protease inhibitors
Can raise aripiprazole concentrations.
Carbamazepine, phenytoin, rifampicin or St John's wort
Can substantially lower aripiprazole concentrations and effectiveness.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.