What parameters should be monitored in patients taking Abilify (aripiprazole)?

From the Guidelines

Patients taking Abilify (aripiprazole) should be monitored for weight, blood glucose, and lipid profiles at baseline and periodically thereafter, as well as psychiatric symptoms, suicidal thoughts, blood pressure, heart rate, and neurological examinations to identify extrapyramidal symptoms and tardive dyskinesia. When monitoring patients on Abilify, it is essential to consider the potential for metabolic changes, including weight gain, and the development of type 2 diabetes and hyperlipidemia, as noted in the American Dietetic Association's recommendations for managing weight gain for patients taking antipsychotics 1.

Key Monitoring Parameters:

• Weight and body mass index (BMI) at baseline, monthly for 3 months, and then quarterly
• Blood pressure at baseline, after 3 months, and then yearly
• Fasting glucose and lipid profiles at baseline, after 3 months, and then yearly
• Psychiatric symptoms, including suicidal thoughts, especially during initial treatment or dose changes
• Neurological examinations to identify extrapyramidal symptoms and tardive dyskinesia
• Complete blood counts periodically to detect rare blood dyscrasias
• Prolactin levels, liver function tests, and electrocardiograms may be warranted in certain patients According to the most recent evidence, regular assessment of these parameters is crucial to ensure the safe and effective use of Abilify 1. Additionally, medication adherence should be assessed regularly, as inconsistent use can lead to symptom relapse. It is also important to note that Abilify can affect multiple body systems due to its action on dopamine and serotonin receptors throughout the body, making regular monitoring essential to minimize potential adverse effects 1.

From the FDA Drug Label

All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for MDD as well as for other indications, both psychiatric and nonpsychiatric Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.

The parameters that should be monitored in patients taking Abilify (aripiprazole) include:

• Suicidality and unusual changes in behavior: especially during the initial few months of treatment or at times of dose changes
• Clinical worsening: monitor for signs of worsening mental health
• Symptoms of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania
• Neuroleptic Malignant Syndrome (NMS): monitor for hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability
• Tardive Dyskinesia: monitor for involuntary, dyskinetic movements
• Weight: clinical monitoring of weight is recommended due to the risk of weight gain associated with atypical antipsychotic use
• Blood lipids: monitor for changes in total cholesterol, fasting triglycerides, fasting LDL cholesterol, and HDL cholesterol
• Blood pressure: monitor and adjust dose accordingly due to the potential for enhanced effect of antihypertensive agents 2, 2, 2

From the Research

Monitoring Parameters for Abilify (Aripiprazole)

When patients are taking Abilify (aripiprazole), several parameters should be monitored due to its potential side effects and interactions. These include:

• Extrapyramidal symptoms (EPS) and tardive dyskinesia: Although aripiprazole has a lower risk of causing EPS compared to typical antipsychotics, monitoring for these symptoms is still necessary, as evidenced by cases of tardive dyskinesia reported in patients taking aripiprazole 3.
• Metabolic parameters: While aripiprazole is associated with a lower risk of metabolic disorders compared to some other atypical antipsychotics, monitoring for changes in weight, glucose, and lipid profiles is recommended 4, 5.
• Suicidal thoughts and anxiety: Patients, especially those with mood disorders, should be monitored for increased anxiety, akathisia, and suicidal thoughts when taking aripiprazole, particularly when combined with other medications like lamotrigine and antidepressants 6.
• Cognitive function: Aripiprazole may improve cognitive function in patients with schizophrenia, but ongoing assessment of cognitive symptoms is necessary 5.
• Prolactin levels and QTc interval: Although aripiprazole is less likely to cause significant changes in prolactin levels or QTc interval prolongation, periodic monitoring may still be warranted, especially in vulnerable populations 4, 5.
• Adherence and side effects: Regular monitoring for common side effects such as nausea, insomnia, agitation, and headache, as well as ensuring patient adherence to the prescribed regimen, is crucial for maintaining efficacy and minimizing discontinuation due to adverse effects 4, 5.