From the FDA Drug Label
The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; The FDA drug label does not answer the question.
From the Research
Antipsychotic medications like Abilify (aripiprazole) and Risperidone should generally be continued through the perioperative period rather than stopped before surgery. Patients should take their regular dose on the morning of surgery unless specifically instructed otherwise by their anesthesiologist or surgeon. Abrupt discontinuation of these medications can lead to withdrawal symptoms or psychiatric decompensation, which could complicate recovery 1. These medications may interact with certain anesthetics and can potentially enhance sedative effects or cause hypotension during surgery, so the anesthesia team should be fully informed about all psychiatric medications.
In some specific cases, dose adjustments might be recommended rather than complete discontinuation. The surgical team should be aware of potential side effects like QT prolongation with some antipsychotics, which may influence cardiac monitoring during surgery. After surgery, oral medications should be resumed as soon as the patient can safely take them, with alternative formulations (liquid, injectable) considered if needed during recovery. The benefits of maintaining psychiatric stability typically outweigh the risks of continuing these medications through the surgical period. A study published in 2021 2 suggests that gradual tapering of antipsychotic treatment may minimize the risk of relapse, but this should be done under close medical supervision and is not typically recommended in the perioperative period.
Key considerations for managing antipsychotic medications in the perioperative period include:
- Maintaining psychiatric stability to prevent withdrawal symptoms or psychiatric decompensation
- Informing the anesthesia team about all psychiatric medications to minimize potential interactions with anesthetics
- Monitoring for potential side effects like QT prolongation and hypotension during surgery
- Resuming oral medications as soon as possible after surgery, with alternative formulations considered if needed.
Overall, the decision to continue or discontinue antipsychotic medications like Abilify and Risperidone before surgery should be made on a case-by-case basis, taking into account the individual patient's medical history, psychiatric stability, and surgical needs, as well as the potential risks and benefits of continuing or discontinuing these medications 3, 4.