What labs should be checked when starting a patient on Abilify (aripiprazole)?

Laboratory Testing When Starting Abilify (Aripiprazole)

Before starting aripiprazole, obtain fasting blood glucose, complete blood count, comprehensive metabolic panel including liver function tests, lipid profile, and body mass index, with ongoing monitoring of metabolic parameters monthly for 3 months then quarterly thereafter. 1, 2

Baseline Laboratory Tests Required

Metabolic Screening

• Fasting blood glucose (or HbA1c if fasting sample unavailable) to screen for diabetes mellitus, as atypical antipsychotics including aripiprazole are associated with hyperglycemia risk 1, 2
• Lipid profile (total cholesterol, LDL, HDL, triglycerides) to establish baseline before potential metabolic changes 1
• Body mass index (BMI) and waist circumference measurement, as weight gain is a known adverse effect of atypical antipsychotics 1

Hematologic and Organ Function

• Complete blood count (CBC) to assess baseline hematologic parameters, particularly important if the patient has history of low white blood cell count 1, 2
• Comprehensive metabolic panel including liver function tests (ALT, AST, alkaline phosphatase, bilirubin), blood urea nitrogen, serum creatinine, and electrolytes (sodium, potassium, calcium, magnesium) 1

Additional Baseline Assessments

• Blood pressure measurement to establish baseline cardiovascular parameters 1
• Pregnancy test for women of childbearing potential before initiating therapy 1, 2

Monitoring Schedule During Treatment

First 3 Months (Intensive Monitoring Phase)

• BMI measurement monthly for the first 3 months to detect early weight gain 1
• Blood pressure monitoring at each visit during initial treatment phase 1
• Fasting glucose should be rechecked at 4 weeks after initiation, then at 3 months 2

After 3 Months (Maintenance Monitoring)

• BMI quarterly after the initial 3-month period 1
• Blood pressure, fasting glucose, and lipids should be followed up after 3 months, then yearly thereafter 1
• Ongoing clinical monitoring for symptoms of hyperglycemia (polydipsia, polyuria, polyphagia, weakness) at every encounter 2

Critical Clinical Considerations

Diabetes Risk Assessment

Patients with established diabetes mellitus should be monitored regularly for worsening glucose control after starting aripiprazole 2. Those with risk factors for diabetes (obesity, family history) require fasting blood glucose testing at treatment initiation and periodically during treatment 2.

Metabolic Syndrome Monitoring

The American Psychiatric Association guidelines emphasize that atypical antipsychotics as a class are associated with significant metabolic problems including type 2 diabetes, hyperlipidemia, and weight gain 1. While aripiprazole has a relatively favorable metabolic profile compared to some other atypicals, systematic monitoring remains essential 3, 4, 5.

Common Pitfalls to Avoid

• Failure to obtain baseline values makes it impossible to determine whether abnormalities are treatment-emergent or pre-existing 1
• Delaying glucose monitoring beyond 4 weeks risks missing early hyperglycemia, which can progress to ketoacidosis or hyperosmolar coma 2
• Inadequate frequency of weight monitoring in the first 3 months when metabolic changes are most likely to emerge 1
• Not screening for pregnancy in women of childbearing potential before initiation 1, 2