From the Research
For patients with both psychosis and gastroparesis, aripiprazole is the preferred antipsychotic option due to its minimal anticholinergic effects and potential to improve gastric motility. Aripiprazole has been shown to be effective in managing psychotic symptoms while also being relatively safe in terms of gastrointestinal side effects 1. The typical dosing is 2-15 mg daily, and it is essential to start with a low dose and gradually increase as needed to minimize adverse events 2.
Key Considerations
- Aripiprazole has a beneficial profile in terms of a low potential for bodyweight gain and extrapyramidal symptoms compared to other antipsychotics 1.
- Low-dose aripiprazole has been found to be effective in patients with ultra-high risk state and first-episode psychosis, with most patients requiring no more than 7.5 mg/d 2.
- Alternative options include low-dose quetiapine (25-200 mg daily), which also has relatively minimal anticholinergic effects compared to other antipsychotics 3.
- Traditional antipsychotics like chlorpromazine, haloperidol, or olanzapine can worsen gastroparesis due to their anticholinergic properties and should be avoided if possible.
Monitoring and Precautions
- Baseline ECG monitoring is recommended as some antipsychotics can prolong the QT interval, which may be particularly concerning in patients with gastroparesis who might have electrolyte abnormalities from vomiting or poor nutrition.
- Patients should be closely monitored for adverse events, and the dose of aripiprazole should be adjusted accordingly to minimize side effects.