From the Guidelines
Aripiprazole augmentation generally does not decrease the efficacy of other antipsychotics and may actually enhance overall treatment response in some patients. When added to existing antipsychotic regimens, aripiprazole (typically at doses of 5-15 mg daily) can work complementarily through its unique partial agonist activity at dopamine D2 receptors, which differs from the full antagonism of most other antipsychotics 1. This pharmacological profile allows aripiprazole to modulate dopamine signaling - increasing it where activity is low and decreasing it where activity is excessive. In clinical practice, aripiprazole augmentation is often used to address residual symptoms or to help mitigate side effects of the primary antipsychotic, such as hyperprolactinemia, metabolic issues, or excessive sedation.
Some key points to consider when using aripiprazole augmentation include:
- Monitoring for potential drug interactions or additive side effects like akathisia, particularly during the first few weeks of treatment 1
- Dose adjustments of either medication may be necessary based on individual response and tolerability 1
- If combining aripiprazole with clozapine or other antipsychotics that have significant pharmacokinetic interactions, more careful monitoring may be warranted 1
- Antipsychotic polypharmacy, including aripiprazole augmentation, may be appropriate for patients who still have symptoms despite treatment attempts with an adequate dose, an adequate choice of therapeutic, and confirmed adherence 1
Overall, the decision to use aripiprazole augmentation should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances. As with any medication, careful monitoring and dose adjustments are necessary to ensure optimal treatment outcomes and minimize potential side effects.
From the Research
Aripiprazole Augmentation and Efficacy of Other Antipsychotics
- The provided studies do not directly address whether aripiprazole augmentation decreases the efficacy of other antipsychotics 2, 3, 4, 5, 6.
- However, the studies suggest that aripiprazole can be an effective augmentation strategy for treatment-resistant major depressive disorder when administered in combination with standard antidepressant therapy 4, 5, 6.
- One study found that aripiprazole augmentation was associated with a significant higher response rate compared with augmentation treatment with bupropion 6.
- Another study found that low-dose aripiprazole as augmentation treatment might achieve the optimal balance between efficacy, tolerability, and acceptability in the acute treatment of antidepressant-refractory depression 2.
Tolerability and Safety of Aripiprazole Augmentation
- The studies suggest that aripiprazole augmentation can be well-tolerated, with common adverse effects including akathisia, insomnia, somnolence, and fatigue 4, 5, 6.
- One study found that medically significant weight gain was higher in studies with patients receiving doses ≥ 5 mg of aripiprazole, and lower in a study using doses < 5 mg 4.
- Another study found that there was no significant difference in adverse events and serious adverse events among aripiprazole augmentation, bupropion augmentation, and switching to bupropion 6.