From the Guidelines
For a patient recently administered Aripiprazole (Abilify) 400mg IM, a suitable PRN medication would be lorazepam 1-2mg, given the patient has already had maximum PRN benzodiazepine and promethazine, and considering the potential risks of using other antipsychotics like haloperidol or risperidone. Given the context, it's crucial to prioritize medications that can effectively manage acute agitation or extrapyramidal symptoms without exacerbating the patient's condition.
- Lorazepam can be administered orally, IM, or IV every 4-6 hours as needed for agitation.
- It's essential to monitor for excessive sedation, especially with benzodiazepines, as noted in 1.
- Avoiding other antipsychotics as PRN medications is recommended due to potential drug interactions and additive side effects with the long-acting aripiprazole injection, as suggested by the management of delirium in adult cancer patients 1.
- The use of haloperidol or risperidone as PRN medications may not be ideal in this scenario, considering the patient's recent administration of a long-acting antipsychotic and the potential for increased side effects or interactions, as indicated in 1.
- The patient's condition and response to PRN medications should be closely monitored, and adjustments made as necessary to ensure optimal management of symptoms and minimize risks.
From the Research
Suitable PRN Medication
Given the patient's recent administration of Aripiprazole 400mg IM, the following options can be considered for PRN medication:
- Haloperidol PRN: According to 2, a low dose of haloperidol added to aripiprazole improved antipsychotic efficacy in a patient with schizophrenia. However, it is essential to exercise caution due to the potential for severe psychotic exacerbation when combining aripiprazole with haloperidol, as reported in 3.
- Risperidone 2mg once per night: There is no direct evidence to support the use of risperidone as a PRN medication in this context. However, 4 suggests that aripiprazole is as effective as risperidone in the short-term treatment of schizophrenia.
Considerations
When selecting a PRN medication, it is crucial to consider the patient's individual needs and medical history. The studies provided do not offer a clear recommendation for a suitable PRN medication in this specific scenario. Therefore, it is essential to weigh the potential benefits and risks of each option and consider alternative treatments.
- The combination of aripiprazole and haloperidol may lead to severe psychotic exacerbation, as reported in 3.
- Aripiprazole has a unique receptor binding profile and is generally well-tolerated, as stated in 4.
- The two-injection start regimen of long-acting aripiprazole has been shown to be safe and effective, according to 5 and 6.