What lab monitoring is required for patients on aripiprazole (Abilify)?

From the Guidelines

Patients taking aripiprazole (Abilify) should have baseline measurements of weight, blood glucose, lipid profile, and prolactin levels, along with a complete blood count and liver function tests, and should be monitored regularly for weight gain, particularly in children and adolescents. Before starting treatment, these baseline measurements are recommended to assess the patient's metabolic and hematological profile 1. During treatment, weight should be monitored regularly, particularly in children and adolescents who are more susceptible to weight gain, and blood glucose and lipid profiles should be checked periodically, especially in patients with risk factors for diabetes or cardiovascular disease 1. Unlike some other antipsychotics, aripiprazole has a lower risk of metabolic side effects, QT prolongation, and hyperprolactinemia, but patients should still be monitored for extrapyramidal symptoms, akathisia, and tardive dyskinesia through clinical assessment 1. Some key points to consider when monitoring patients on aripiprazole include:

• Baseline measurements: weight, blood glucose, lipid profile, prolactin levels, complete blood count, and liver function tests
• Regular monitoring: weight, blood glucose, and lipid profiles, especially in patients with risk factors for diabetes or cardiovascular disease
• Clinical assessment: extrapyramidal symptoms, akathisia, and tardive dyskinesia
• Considerations: patients with pre-existing conditions, combination with other medications, and potential adverse effects 1.

From the FDA Drug Label

Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness

Lab Monitoring for Patients on Aripiprazole:

• Glucose monitoring: Patients with diabetes or risk factors for diabetes should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment.
• Lipid monitoring: Although the label does not specify the frequency of lipid monitoring, it is recommended to monitor lipid profiles periodically, especially in patients with risk factors for dyslipidemia.
• Weight monitoring: Clinical monitoring of weight is recommended, especially in patients with risk factors for weight gain.
• Symptom monitoring: Patients should be monitored for symptoms of hyperglycemia, including polydipsia, polyuria, polyphagia, and weakness. 2

From the Research

Lab Monitoring for Patients on Aripiprazole

• Aripiprazole is an atypical antipsychotic drug with a unique pharmacological profile, and its clinical effects are best documented in patients suffering from schizophrenia and bipolar disorder 3.
• The most commonly reported side effects of aripiprazole include restlessness/akathisia, somnolence, and nausea, which may be dose-dependent and usually occur early on during treatment 3.
• Serum levels of aripiprazole and its active metabolite dehydroaripiprazole are highly variable between individuals, and distinct ranges are associated with good therapeutic response and minimal side effects 4.
• Therapeutic drug monitoring may be helpful to improve the antipsychotic drug therapy, as improvement was best in patients with a serum level between 150 and 300 ng/ml 4.
• Aripiprazole can cause hypertriglyceridemia, and triglyceride levels should be carefully monitored in patients with mental disorders taking aripiprazole 5.
• Patients with mental disorders are at high risk for developing dyslipidemia, diabetes, and the full criteria of the metabolic syndrome, and antipsychotic use exacerbates this risk 5.
• Aripiprazole is associated with fewer metabolic disturbances and has a favourable cardiovascular tolerability profile compared to some other atypical antipsychotics 6, 7.
• The efficacy of aripiprazole as a maintenance treatment for schizophrenia has been demonstrated in randomized clinical trials, and it is generally well tolerated with a tolerability profile consistent with that of oral aripiprazole 7.