Medication Overview

Abilify, generic name aripiprazole, is an atypical antipsychotic primarily prescribed for the treatment of schizophrenia, bipolar disorder, and as an adjunct in major depressive disorder. It works by modifying the action of certain neurotransmitters in the brain, including dopamine and serotonin.

Dosage Forms Available

Abilify is available in multiple forms: oral tablets, orally disintegrating tablets, oral solution, and injectable formulations. The strengths of oral tablets range from 2 mg to 30 mg. Orally disintegrating tablets come in 10 mg and 15 mg strengths, while the injectable forms vary based on patient requirements.

Administering The Medication

Administer Abilify exactly as prescribed by the healthcare provider. It can be taken with or without food. Oral tablets should be taken whole, while orally disintegrating tablets should be allowed to dissolve on the tongue without chewing. Shake the oral solution well before measuring the dose. Injectable forms must be administered by a healthcare professional.

Treatment Indications

Abilify is indicated for the treatment of schizophrenia in adults and adolescents aged 13-17 years. It is also used for the management of bipolar I disorder in adults and pediatric patients aged 10-17 years. Additionally, Abilify can be used as an adjunct treatment for major depressive disorder in adults.

Mechanism Of Action

Abilify acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A receptors. This unique mechanism helps to stabilize the dopaminergic and serotonergic systems, which are implicated in mood and psychotic disorders.

Starting Dosage

The initial dose for schizophrenia in adults usually starts at 10-15 mg daily. For bipolar disorder, the starting dose is generally 15 mg once daily. As an adjunct for major depressive disorder, initial dosing typically begins at 2-5 mg daily. Adjustments may be made based on clinical response and tolerability.

Maximum Dosage Limit

For schizophrenia and bipolar disorder, the maximum recommended daily dose is 30 mg. In the adjunctive treatment of major depressive disorder, the upper limit generally does not exceed 15 mg per day. Exceeding these doses may increase the risk of adverse effects without additional therapeutic benefits.

Dosage Adjustments

Dosage adjustments may be necessary for patients with hepatic or renal impairment. Clinical judgment should guide any adjustments necessary to avoid adverse effects. Geriatric patients may also require lower dosages due to increased sensitivity to the drug.

Drug Interactions

Abilify can interact with other medications that affect the cytochrome P450 system, particularly CYP2D6 and CYP3A4. These interactions may require dosage adjustments. Combining Abilify with CNS depressants or substances like alcohol can enhance sedative effects.

Common Adverse Effects

Common side effects of Abilify include nausea, vomiting, constipation, headache, dizziness, and restlessness. Some patients may experience weight gain and akathisia, a sense of inner restlessness. Monitoring for these side effects is recommended.

Severe Adverse Effects

Serious side effects may include tardive dyskinesia, neuroleptic malignant syndrome, and significant changes in blood sugar levels. Immediate medical attention is necessary if symptoms suggesting these conditions arise. Suicidal thoughts or behavior require urgent assessment and intervention.

Pregnancy Category

Abilify is categorized as pregnancy category C. The potential benefits should be weighed against the possible risks to the fetus. Healthcare providers should discuss these risks with pregnant patients or those planning to become pregnant.

Laboratory Monitoring

Regular laboratory monitoring may be required, including blood glucose levels, lipid profiles, and complete blood counts. Regular weight assessments are also recommended to detect significant changes early and manage them accordingly.

Withdrawal Symptoms

Discontinuing Abilify abruptly can lead to withdrawal symptoms such as nausea, vomiting, sweating, and insomnia. Gradual tapering as per healthcare provider guidelines can help mitigate these effects.

Storage Conditions

Store Abilify tablets at room temperature, away from moisture and heat. The oral solution should be stored in the original container and the lid tightly closed when not in use. Injectable forms should be stored as per the manufacturer’s recommendations.

Patient Counseling Points

Patients should be advised to take Abilify as prescribed and not discontinue the medication without consulting their healthcare provider. They should be informed about potential side effects and the importance of regular follow-up appointments for monitoring. Patients should also be alerted to the potential for interaction with other medications or substances, including alcohol.

Handling Missed Doses

If a dose is missed, patients should be instructed to take it as soon as they remember. If it is almost time for the next dose, they should skip the missed dose and resume their regular dosing schedule. Doubling up on doses to make up for a missed one is not recommended.

Potential Benefits

Abilify offers the potential benefits of mood stabilization, reduction in psychotic symptoms, and improved overall functioning in individuals with schizophrenia and bipolar disorder. As an adjunct for major depressive disorder, it may enhance the effectiveness of antidepressants.

Renal Impairment Considerations

For patients with renal impairment, dosage adjustment may be necessary. Regular monitoring of renal function tests is recommended for early detection of any changes necessitating dosage modifications.

Hepatic Impairment Considerations

In patients with hepatic impairment, careful dosing and therapeutic monitoring are essential. Liver function tests should be performed regularly to ensure hepatic safety and to make any necessary dosage adjustments.

Pharmacokinetic Properties

Abilify has a mean half-life of approximately 75 hours, allowing for once-daily dosing. It is extensively metabolized in the liver, with elimination occurring primarily via hepatic pathways. Peak plasma concentrations are typically reached within 3-5 hours after oral administration.

Effects on Driving

Abilify can impair motor coordination, so patients should be advised not to operate heavy machinery or drive until they know how the medication affects them. Careful assessment of cognitive function is recommended before advising on safely resuming these activities.

Hematologic Effects

Abilify may potentially cause leukopenia, neutropenia, and agranulocytosis. Regular complete blood count tests are suggested to monitor for these hematologic effects, particularly during the initial months of therapy.