Aripiprazole

Aripiprazole is an injected drug available only from a licensed physician that is used primarily to treat agitation experienced by patients

Overview

What is Aripiprazole?

Aripiprazole is a drug administered by injection in patients who are experiencing agitation or episodes caused by schizophrenia or bipolar disorder. Aripiprazole is available only with a doctor’s prescription and comes in a liquid solution or powder that is intended to be mixed into a suspension. Either form of Aripiprazole is intended to be injected into the patient via syringe.

Health care providers will make Aripiprazole powder into a solution using a solvent, and will then inject this solution into the gluteal or deltoid (buttock or shoulder) muscle. Your dosage will depend on what your doctor prescribes based on your overall health, symptoms and other factors.

How does Aripiprazole work?

Aripiprazole works by adjusting the levels of dopamine and other chemicals that the brain uses to maintain normal function. Aripiprazole acts to block dopamine production when the level is too high and stimulates the production of dopamine when the levels are too low.

Considered an atypical antipsychotic agent drug, it is used in injected form for treatment of agitated episodes in patients with schizophrenia or bipolar disorder. The injected for of Aripiprazole is fast acting and strong and intended for use in the rapid control of agitation and disturbed behavior, but it should be discontinued in favor of oral therapy with a lower dose when the time is right.

Suicidal thoughts and tendencies to self-harm have been reported with use of Aripiprazole, though it is unknown whether this is the result of a side effect of the drug or a natural condition found in patients who have the brain conditions being treated to start with.

What is schizophrenia?

Schizophrenia is a severe mental health condition that causes a range of different symptoms and psychological problems. Characterized as a form of psychosis, schizophrenia is a long-term disease in which the patient may not always be able to distinguish their dreams, thoughts and ideas from everyday reality.

Symptoms of schizophrenia include hallucinations, delusions, muddled thoughts based on these hallucinations or delusions, as well as changes in behavior. Not to be confused with split personality disorder or violent behavior due to drug and alcohol abuse, schizophrenia is not caused by outside substances nor does it develop into other disorders.

Brain studies on schizophrenic patients have shown subtle differences in brain structure, which suggests that schizophrenia may be partly a brain disorder. Two chemicals that are important to normal brain function are dopamine and serotonin; these neurotransmitter chemicals are out of balance in patients diagnosed with schizophrenia.

What is bipolar disorder?

Bipolar disorder is a mental disorder causing periods of depression and periods of elevated mood. During elevated mood periods, known as mania or hypomania, the patient feels abnormally happy, energetic or irritable. The manic person may make poor decision with no regard to consequences of their actions and they typically sleep and eat very little, existing on the high experienced during the manic episode. During periods of depression, the patient will have a negative outlook on life and have bouts of crying and even thoughts of suicide or self-harm.

Causes of bipolar disorder aren’t clear, but like schizophrenia, chemicals in the brain at an imbalance are blamed for being part of the cause while environmental factors and triggers definitely pay a part. The condition can be hereditary to the cause of child abuse or long term stress from a parent who was also bipolar. Symptoms of bipolar disorder include these periods of depression and mania, which are far more intense than simple mood swings. Extreme episodes of bipolar disorder can last several weeks or longer with the patient rarely experiencing a regular mood period. Bipolar disorder makes it difficult for patients to lead a normal, productive life, as their manic periods and depressed periods are difficult for most people to understand.

Conditions treated

  • Agitation due to schizophrenia or bipolar mania

Type of medicine

  • Antipsychotic agent

Side effects

Different patients experience different side effects in relation to treatment with Aripiprazole. Every patient is different and not all side effects are experienced by all patients. The following is a list of common side effects:

  • Difficulty speaking
  • Drooling
  • Loss of balance
  • Muscle trembling, jerking, or stiffness
  • Restlessness
  • Shuffling walk
  • Stiffness of the limbs
  • Twisting movements of the body
  • Uncontrolled movements, especially of the face, neck, and back

If these side effects are severe or prolonged, notify your health care provider right away. The following is a list of further side effects that are considered less common to patients being treated with Aripiprazole:

  • Blurred vision
  • Dizziness
  • Fast, pounding, or irregular heartbeat
  • Headache
  • Inability to move the eyes
  • Increased blinking or spasms of the eyelid
  • Nervousness
  • Ear pounding
  • Sticking out the tongue
  • Trouble breathing or swallowing
  • Unusual facial expressions
  • Convulsions
  • Fast heartbeat
  • High fever
  • Increased sweating
  • Lip smacking or puckering
  • Loss of bladder control
  • Muscle spasm or jerking of extremities
  • Puffing of the cheeks
  • Rapid or worm-like movements of the tongue
  • Severe muscle stiffness
  • Sudden loss of consciousness
  • Tiredness
  • Uncontrolled chewing movements
  • Uncontrolled movements of the arms and legs
  • Unusually pale skin
  • Hives or welts, itching, or skin rash
  • Itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Swelling on face that is large and red
  • Swollen eyes, lips, tongue, hands, feet, throat, sex organs or legs
  • Skin redness
  • Chest tightness
  • Strange fatigue for no reason
  • Weakness

These symptoms could be signs of a permanent, life-threatening condition caused by a reaction to Aripiprazole. If you experience any of these side effects while being treated with Aripiprazole, contact your physician right away to determine if you should continue this drug treatment.

Side effects that are severe or prolonged should be reported to your health care provider immediately. Seek your doctor’s advice on how to prevent or reduce side effects that could be experienced with Aripiprazole.

Dosage

Aripiprazole will be administered to patients via injection into a muscle only in a hospital setting. Aripiprazole injection is typically administered in conjunction with other oral medications for the initial dose. The second and following doses are given instead of oral medications.

The recommended starting dose is 400 milligrams, but this could vary depending on the treatment regimen your doctor has in mind. Oral medication is typically given for the next 14 days, with injections that follow as recommended by the doctor.

Read your medication guide that will be given to you by your health care provider and make sure you understand all the information. If you have questions, discuss these with your doctor right away.

Make sure you keep all appointments for future injections as this medication needs to be given on a fixed schedule to help in regulating the brain chemical activity and stabilizing your mood.

Interactions

Inform your health care provider if you have ever had an allergic reaction to Aripiprazole or any other medications or if you are allergic to any foods, dyes, preservatives or animals.

There have been no appropriate studies on the effectiveness of Aripiprazole on pediatric patients, nor has it been proven safe for this age group. Geriatric patients have not been studied for Aripiprazole safety or efficacy either, but it is known that elderly patients who have dementia or Alzheimer disease should not be prescribed Aripiprazole.

Women who are pregnant or breastfeeding have not been studied to determine the risks they might possibly pass down to their infants by using Aripiprazole. Your doctor will discuss the potential risks and benefits of being treated with this medication if you are pregnant, about to become pregnant or breastfeeding.

Use of Aripiprazole with the following medications is not recommended:

  • Amifampridine
  • Amisulpride
  • Bepridil
  • Bromopride
  • Cisapride
  • Dronedarone
  • Fluconazole
  • Mesoridazine
  • Metoclopramide
  • Pimozide
  • Piperaquine
  • Posaconazole
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

If you are currently on these medications, your doctor may make changes to your dosage or recommend other treatments than Aripiprazole.

The following medications are known to interact with Aripiprazole but may be necessary:

  • Alfentanil
  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Anagrelide
  • Apomorphine
  • Arsenic Trioxide
  • Asenapine
  • Astemizole
  • Atazanavir
  • Azithromycin
  • Bedaquiline
  • Boceprevir
  • Bromazepam
  • Buprenorphine
  • Bupropion
  • Buserelin
  • Butorphanol
  • Carbamazepine
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Cobicistat
  • Codeine
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Dasatinib
  • Degarelix
  • Delamanid
  • Desipramine
  • Deslorelin
  • Dihydrocodeine
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Donepezil
  • Doxepin
  • Doxylamine
  • Droperidol
  • Ebastine
  • Efavirenz
  • Enzalutamide
  • Eribulin
  • Erythromycin
  • Escitalopram
  • Famotidine
  • Felbamate
  • Fentanyl
  • Fingolimod
  • Flecainide
  • Flibanserin
  • Fluoxetine
  • Formoterol
  • Foscarnet
  • Fosphenytoin
  • Galantamine
  • Gatifloxacin
  • Gemifloxacin
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Histrelin
  • Hydrocodone
  • Hydromorphone
  • Hydroquinidine
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibutilide
  • Idelalisib
  • Iloperidone
  • Imipramine
  • Indinavir
  • Itraconazole
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Leuprolide
  • Levofloxacin
  • Lopinavir
  • Lumefantrine
  • Mefloquine
  • Meperidine
  • Methadone
  • Metronidazole
  • Mifepristone
  • Milnacipran
  • Mitotane
  • Mizolastine
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nafarelin
  • Nelfinavir
  • Nilotinib
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Ondansetron
  • Oxymorphone
  • Paliperidone
  • Panobinostat
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Pentazocine
  • Periciazine
  • Perphenazine
  • Phenytoin
  • Pimavanserin
  • Pipamperone
  • Pitolisant
  • Probucol
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Remifentanil
  • Rifampin
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Sertindole
  • Sevoflurane
  • Sodium Phosphate
  • Solifenacin
  • Sorafenib
  • Sotalol
  • St John's Wort
  • Sufentanil
  • Sulpiride
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Tapentadol
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Tizanidine
  • Tolterodine
  • Toremifene
  • Tramadol
  • Trazodone
  • Trimipramine
  • Triptorelin
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Vilanterol
  • Vinflunine
  • Voriconazole
  • Vorinostat
  • Zuclopenthixol

Using Aripiprazole and eating grapefruit or drinking grapefruit juice is not recommended. Additionally, use of illegal drugs, alcohol or tobacco products should be discussed with your health care provider. It is specifically recommended that use of alcohol be avoided when under treatment with Aripiprazole to avoid unwanted side effects.

Medical problems such as those listed below are also at risk for worsening symptoms and overall safety of health in patients who are given Aripiprazole injection:

  • Blood vessel disease
  • Dehydration
  • Heart attack or stroke
  • Heart disease
  • Heart failure
  • Heart rhythm problems
  • Hypotension (low blood pressure)
  • Hypovolemia (decrease in the volume of blood)
  • Ischemic heart disease
  • Trouble swallowing
  • Depression
  • Diabetes or family history of diabetes
  • Dyslipidemia (high cholesterol or fats in the blood)
  • Hyperglycemia (high blood sugar)
  • Neuroleptic malignant syndrome (NMS)
  • Neutropenia (low white blood cells)
  • Reduced white blood cell count
  • Seizures

If you have been diagnosed with any of these conditions or experienced them in your medical history, you may be at risk for worsening symptoms and health conditions that could be irreversible. Suicidal thoughts and behaviors have been reported during drug treatment therapy with Aripiprazole. If you are having any thoughts or feelings about self harm or suicide, tell your health care provider immediately or seek help by any means available to you.

If you experience weight gain, develop unusual body movements or experience fatigue symptoms that interfere with normal daily life or if you develop difficulty swallowing or other allergy symptoms, contact your health care provider right away.

Aripiprazole is not recommended for children under 18 years of age as it has not been proven effective or safe for this age group. Patients who are being treated with medication to lower blood pressure may be at risk for increased effect in these medications. Your doctor should be told if you are taking medication to regulate blood pressure.

It is of critical importance that your disclose your full medical history as well as details of any drugs you are currently taking or have taken in the recent past before you begin a course of treatment with Aripiprazole or any other drug. Make sure to give your physician a list of all prescription as well as non-prescription medications you may be taking and details of any holistic, herbal or vitamin supplements or treatments you are currently taking or have taken in the recent past.

Patients are urged to fully disclose all prescription and non-prescription drugs they are currently taking or have taken in the recent past as well as any vitamin, herbal or holistic supplements and remedies they are on during treatment with Aripiprazole.

Until you know how Aripiprazole affects your balance and other motor skills, do not drive or use heavy machinery or power tools until you are aware of your specific side effects on this drug. Your doctor will be able to advise you on these side effects.

Overdose symptoms include:

  • Rapid heartbeat
  • Agitation or aggressiveness
  • Speech problems
  • Unusual movements especially in the face or tongue
  • Reduced level of consciousness
  • Acute confusion
  • Seizures
  • Coma
  • Fever
  • Rapid breathing
  • Sweating
  • Muscle stiffness
  • Drowsiness or sleepiness
  • Slower breathing
  • Choking
  • High or low blood pressure
  • Abnormal heart rhythms

Contact your physician right away if you experience symptoms of overdose and fear you have been administered too much Aripiprazole injection.

Storage

To properly and safely store Aripiprazole, keep it in the original packaging with the container closed at room temperature. Do not expose Aripiprazole to excessive heat, light or moisture and never allow it to freeze. This and all medications should be kept out of sight and reach of children. When it comes time to dispose of expired or unused Aripiprazole, consult your doctor or pharmacist for the safest way to do so.

Reconstituted suspension of Aripiprazole should be used immediately but can be stored in the refrigerator for up to 4 hours. Do not store in the syringe. Do not use Aripiprazole after the expiry date has passed.

Summary

Aripiprazole, in the injected format, is used to calm agitation in patients diagnosed with schizophrenia or bipolar mania. Aripiprazole injection is a fast acting, potent drug that regulates levels of dopamine in the brain to bring down manic episodes and regulate mood.

Side effects of this drug include drooling, difficulty speaking, loss of balance, stiff muscles, trembling or jerking muscles and walking restlessly or shuffling, stiffness in limbs, twisting body motions and overall uncontrolled body movements. Patients who experience balance or vision problems, increased nervousness, weight gain or any allergic reactions should contact their physicians immediately.

Aripiprazole is not appropriate for use in children under 18 years of age, in geriatric patients with the intent of treating Alzheimer disease symptoms or dementia symptoms or in pregnant or breastfeeding women.

Suicidal thoughts and tendencies to self-harm have been reported with use of Aripiprazole. Notify your health care provider immediately if you feel suicidal or deep depression.

Aripiprazole has a long list of drug interactions as well as increased risks for patients diagnosed with other health conditions. It is imperative to discuss any prescription or non-prescription medications you are currently taking or have taken in the past along with any vitamin, herbal or holistic remedies you practice. Inform your physician if you are on medication for high or low blood pressure, as Aripiprazole could influence how effective these medications are. Full medical history should be given to your physician to determine if you are at risk for worsening any pre-existing conditions or if you have family history of conditions that could manifest with use of Aripiprazole.

Aripiprazole will be administered in a hospital setting, where appropriate storage, maintenance and disposal will be up to the professionals on the medical staff. The un-suspended powder format of the drug should be stored at room temperature out of direct heat, moisture and light exposure and out of sight and reach of children. Suspended solution of Aripiprazole should be used within hours of mixing but can be stored in the refrigerator as long as it is not in the syringe.