What is the interaction between Aripiprazole (Abilify) and Lorazepam (Ativan)?

From the Guidelines

The interaction between Aripiprazole (Abilify) and Lorazepam (Ativan) is generally safe, but caution is advised due to the potential for increased sedation and respiratory depression, particularly when used in combination at high doses 1.

Key Considerations

• Aripiprazole is a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors, while lorazepam is a benzodiazepine that exerts its CNS depressant effect by binding to presynaptic γ-aminobutyric acid (GABA) receptors.
• The combination of aripiprazole and lorazepam may be used in the management of delirium or agitation, but the use of pharmacological interventions should be limited to patients who have distressing delirium symptoms or if there are safety concerns where the patient is a potential risk to themselves or others 1.
• When using aripiprazole and lorazepam together, it is essential to monitor patients for signs of excessive sedation, respiratory depression, and other adverse effects, and to adjust the doses accordingly.
• The starting dose of aripiprazole is typically 5 mg p.o. or i.m. (immediate-release) stat, while the starting dose of lorazepam is typically 0.5-1 mg p.o. or s.c. stat.

Potential Risks and Benefits

• The benefits of using aripiprazole and lorazepam together include improved management of delirium or agitation symptoms, and potentially reduced risk of relapse or hospitalization.
• However, the potential risks include increased sedation, respiratory depression, and other adverse effects, particularly when used in combination at high doses.
• It is crucial to weigh the potential benefits and risks of using aripiprazole and lorazepam together and to closely monitor patients for any adverse effects.

Clinical Practice Guidelines

• The use of pharmacological interventions in the management of delirium in adults should be limited to patients who have distressing delirium symptoms or if there are safety concerns where the patient is a potential risk to themselves or others 1.
• Medications should be used in the lowest effective dose and for a short period of time only, and patients should be closely monitored for any adverse effects.
• The clinical decision to use aripiprazole and lorazepam together should involve an assessment of the level of patient distress, the safety risks with and without administering the medications, and patient mobility.

From the FDA Drug Label

The intensity of sedation was greater with the combination of oral aripiprazole and lorazepam as compared to that observed with aripiprazole alone. The orthostatic hypotension observed was greater with the combination as compared to that observed with lorazepam alone [seeWarningsandPrecautions ( 5.8)]. Monitor sedation and blood pressure. Adjust dose accordingly. Based on pharmacokinetic studies, no dosage adjustment of aripiprazole is required when administered concomitantly with famotidine, valproate, lithium, lorazepam.

The interaction between Aripiprazole (Abilify) and Lorazepam (Ativan) is that the combination may increase the intensity of sedation and orthostatic hypotension.

• Key points:
  • Increased sedation
  • Increased orthostatic hypotension
  • No dosage adjustment is required for aripiprazole when administered concomitantly with lorazepam
• Clinical recommendation: Monitor sedation and blood pressure. Adjust dose accordingly 2

From the Research

Interaction between Aripiprazole and Lorazepam

There is no direct evidence in the provided studies regarding the interaction between Aripiprazole (Abilify) and Lorazepam (Ativan).

Pharmacological Properties of Aripiprazole

• Aripiprazole is a quinolinone derivative with a high affinity for dopamine D2 and D3 receptors, and serotonin 5-HT1A, 5-HT2A, and 5-HT2B receptors 3
• The mechanism of action of aripiprazole is not yet known, but evidence suggests that its efficacy in the treatment of the positive and negative symptoms of schizophrenia and its lower propensity for extrapyramidal symptoms (EPS) may be attributable to aripiprazole's partial agonist activity at dopamine D2 receptors 3
• Aripiprazole is rapidly absorbed after oral administration, with a mean time to peak plasma concentration of 3 hours following multiple-dose administration of aripiprazole 10 or 15 mg 3

Therapeutic Efficacy of Aripiprazole

• The efficacy of aripiprazole has been demonstrated in patients with schizophrenia or schizoaffective disorder 3, 4, 5
• Aripiprazole may improve cognitive function, with patients with chronic schizophrenia receiving aripiprazole 30 mg/day experiencing similar or better changes from baseline in neurocognitive parameters compared with recipients of olanzapine 10-15 mg/day 3

Combination Therapy with Aripiprazole

• The combination of aripiprazole with mood stabilizers seems to offer an effective and relatively well-tolerated option for the treatment of acute mania and for the maintenance treatment of patients with bipolar I disorder 6
• Aripiprazole is generally well tolerated compared with other antipsychotic medications, although commonly reported side effects include extrapyramidal symptoms and motoric activation similar to akathisia 7