What is the use of Aripiprazole (Abilify)?

From the Guidelines

Aripiprazole should be considered as a potential add-on treatment to clozapine in patients with schizophrenia who have residual symptoms despite adequate trials of clozapine monotherapy, as it may help reduce side effects and improve treatment outcomes. This approach is supported by recent studies, including one published in 2021 1, which suggests that combining aripiprazole with clozapine may be effective in reducing treatment side effects and residual symptoms.

Key Points to Consider

• Aripiprazole is an atypical antipsychotic that acts as a partial agonist at dopamine D2 receptors, which helps reduce side effects like movement disorders and prolactin elevation 1.
• The typical starting dose for adults with schizophrenia is 10-15 mg once daily, which can be increased to a maximum of 30 mg daily if needed 1.
• Common side effects of aripiprazole include weight gain, akathisia, insomnia, and nausea, although it tends to have a lower side effect burden compared to other antipsychotics 1.
• Antipsychotic polypharmacy, including the use of aripiprazole with other antipsychotics like clozapine, may be considered in patients who do not respond to monotherapy, but it should be approached with caution due to the potential for increased side effects and drug interactions 1.

Clinical Considerations

• Patients should be closely monitored for side effects and treatment outcomes when using aripiprazole, especially when combined with other antipsychotics.
• The use of aripiprazole as an add-on treatment to clozapine should be individualized and based on a thorough assessment of the patient's treatment history and response to previous therapies.
• Clinicians should be aware of the potential for drug interactions and adjust dosing accordingly to minimize adverse effects.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Aripiprazole

• Aripiprazole is a second-generation antipsychotic (SGA) that has been approved for the treatment of schizophrenia and bipolar disorder 2.
• It has a unique pharmacological profile, acting as a partial dopaminergic agonist and exhibiting partial agonism at serotonin(1A) receptors and antagonism at serotonin(2A) receptors 2, 3.

Clinical Efficacy

• Aripiprazole has been shown to be effective in reducing symptomatology associated with schizophrenia-related disorders compared to placebo 2.
• It has also been found to be effective in the treatment of mania in bipolar I disorder, with a recommended initial dose of 15 mg/day 4.
• Clinical trials have demonstrated that aripiprazole is superior to placebo in dose ranges of 10-30 mg/day for the treatment of schizophrenia and bipolar disorder 3.

Safety and Tolerability

• Aripiprazole has been found to have a favorable safety and tolerability profile, with a low propensity to cause extrapyramidal symptoms, weight gain, cardiovascular abnormalities, hyperprolactinemia, hypercholesterolemia, or glucose dysregulation 2.
• Common side effects include restlessness/akathisia, somnolence, and nausea, which may be dose-dependent and usually occur early on during treatment 3.
• Aripiprazole has been found to be well-tolerated in elderly patients, although it may be associated with an increased risk of adverse events such as stroke and urinary symptoms 5.

Clinical Use

• Aripiprazole can be used as a monotherapy or as an adjunctive treatment for schizophrenia and bipolar disorder 6.
• It is recommended to initiate treatment with aripiprazole at 15 mg/day, with adjustments made as needed to manage side effects or symptoms 4.
• When switching to aripiprazole, the therapeutic dose of current treatment should be maintained while adding aripiprazole, and only once an effective dose of aripiprazole is reached should previous medication be reduced 4.