Is intramuscular (IM) Abilify (aripiprazole) effective for treating aggression?

From the Guidelines

Intramuscular (IM) Abilify (aripiprazole) is not the first-line treatment for acute agitation and aggression, and benzodiazepines or other antipsychotics may be preferred, as suggested by the 2016 Pediatrics study 1. When considering the management of acute agitation and aggression, it's essential to evaluate the suspected etiology of agitation, as outlined in TABLE 3 of the study 1. For psychiatric causes, antipsychotics like Abilify may be considered, but benzodiazepines are often preferred for their rapid onset of action and efficacy in reducing agitation. Some key points to consider when managing acute agitation and aggression include:

• Verbal restraint strategies, such as respecting personal space, minimizing provocative behavior, and establishing verbal contact, as outlined in TABLE 2 of the study 1
• The use of benzodiazepines, such as lorazepam, midazolam, or diazepam, which can be effective in reducing agitation, as discussed in the study 1
• The potential side effects and limitations of antipsychotics, including extrapyramidal symptoms and sedation, as mentioned in the study 1 In terms of specific medication considerations, the study suggests that benzodiazepines may be preferred for mild to moderate agitation, while antipsychotics like Abilify may be considered for severe agitation or when benzodiazepines are not effective 1. However, it's crucial to prioritize the patient's safety and well-being, and to carefully evaluate the potential benefits and risks of each treatment option.

From the Research

IM Abilify for Aggression

• The use of intramuscular (IM) aripiprazole, also known as Abilify, for the treatment of aggression and agitation has been studied in several clinical trials 2, 3, 4, 5, 6.
• A systematic review of pharmacologic treatments for agitation found that IM aripiprazole was effective in reducing agitation in patients with schizophrenia or bipolar disorder 2.
• A study on the acute management of psychomotor agitation found that IM aripiprazole significantly improved clinical measures of agitation, with effects sustained for up to 24 hours 3.
• A consensus statement on the use of IM aripiprazole for the rapid control of agitation in bipolar mania and schizophrenia found that aripiprazole demonstrated a favorable efficacy and safety profile 4.
• A Cochrane review of IM aripiprazole for psychosis-induced aggression or agitation found that aripiprazole was effective compared to placebo and haloperidol, but not when compared to olanzapine 5.
• A systematic review and meta-analysis of pharmacological interventions for acute agitation found that olanzapine, haloperidol plus promethazine, and droperidol were most effective and safe for use as rapid tranquilization, while midazolam sedated most quickly but had increased saturation problems 6.

Efficacy of IM Aripiprazole

• IM aripiprazole has been shown to be effective in reducing agitation in patients with schizophrenia or bipolar disorder, with response rates ranging from 83.6% to over 90% 3, 5.
• The effects of IM aripiprazole on agitation have been found to be sustained for up to 24 hours, with significant improvements in clinical measures of agitation starting as early as 30 minutes after administration 3.

Safety of IM Aripiprazole

• IM aripiprazole has been found to be generally safe and well-tolerated, with few adverse effects reported in clinical trials 3, 5.
• However, one study found that aripiprazole was associated with more adverse effects compared to placebo, although the difference was not significant 5.