What baseline laboratory tests and follow‑up monitoring schedule are recommended before initiating and after starting injectable aripiprazole (Abilify Maintena or Abilify MyCite) in an adult patient, including considerations for women of child‑bearing potential, cardiac disease, and prolactin‑related symptoms?

Laboratory Monitoring for Injectable Aripiprazole (Abilify Maintena)

Baseline Laboratory Tests Required Before Initiation

Before starting injectable aripiprazole, obtain fasting blood glucose (or HbA1c), complete blood count, comprehensive metabolic panel including liver function tests, lipid profile, and body mass index. 1

Metabolic Screening

• Fasting blood glucose or HbA1c to assess diabetes risk, as atypical antipsychotics including aripiprazole are associated with hyperglycemia 1
• Complete lipid profile (total cholesterol, LDL, HDL, triglycerides) to establish baseline for monitoring metabolic changes 1
• Body mass index (BMI) and waist circumference measurement, as weight gain is a known adverse effect 1

Hematologic and Organ Function

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

Cardiovascular Assessment

• Blood pressure measurement to establish baseline cardiovascular parameters 1

Women of Childbearing Potential

• Pregnancy test must be performed before initiating therapy 1

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Follow-Up Monitoring Schedule After Initiation

First 3 Months (Intensive Phase)

• BMI measurement monthly to detect early weight gain 1
• Blood pressure at each visit during the initial treatment phase 1

At 3 Months

• Fasting glucose or HbA1c reassessment 1
• Lipid profile (cholesterol, triglycerides) 1
• BMI and waist circumference re-measurement 1
• Blood pressure re-check 1

After 3 Months (Maintenance Phase)

• BMI quarterly after the initial 3-month period 1
• Blood pressure, fasting glucose, and lipids yearly thereafter 1

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Special Considerations

Metabolic Risk Context

The American Psychiatric Association emphasizes that atypical antipsychotics as a class are associated with significant metabolic problems including type 2 diabetes, hyperlipidemia, and weight gain. 1 Aripiprazole tends to have fewer metabolic effects compared to agents like olanzapine, clozapine, quetiapine, and risperidone. 2

Cardiac Disease Considerations

For patients with cardiac risk factors or those over 40 years, baseline ECG assessment is prudent given potential for QT prolongation and orthostatic hypotension with antipsychotics, though aripiprazole has a favorable cardiovascular tolerability profile. 3

Prolactin Monitoring

Aripiprazole uniquely tends to lower rather than raise prolactin levels, distinguishing it from most other antipsychotics. 4 Baseline prolactin measurement may be considered if prolactin-related symptoms are present, though routine monitoring is not typically required given aripiprazole's mechanism as a partial dopamine agonist. 3

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Critical Clinical Pitfalls to Avoid

• Failure to obtain baseline values makes it impossible to determine whether abnormalities are treatment-emergent or pre-existing 1
• 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
• Assuming all antipsychotics have identical metabolic profiles—aripiprazole has demonstrably lower risk for weight gain and metabolic disturbances compared to many alternatives 5, 3