Aripiprazole adverse effects

Sprinkle capsule 15, 25 mg Atypical Antipsychotics FDA approved for use in bipolar disorder Aripiprazole Abilify Tablets 5, 10, 15, Dosage should be slowly increased to minimize adverse effects (e.g., 25 mg at bedtime for 1 week, then 25-50 mg/day increments at weekly intervals) 10-30 mg/day once daily acute treatment of mania or mixed episodes due to lack of efficacy used as an adjunctive agent with established mood stabilizers Use as monotherapy or in... 

A 29-year-old woman with a schizoaffective disorder took haloperidol 5 mg/day and then 9 mg/day because of acute psychotic episodes. She had no adverse effects such as amenorrhea or galactorrhea. Haloperidol was then replaced by aripiprazole 15 mg/day and on the evening of the second day she developed breast tenderness and marked galactorrhea. The serum prolactin concentration was 32 ng/ml (reference range 5-25 ng/ ml). Aripiprazole was withdrawn and haloperidol restarted. The galactorrhea resolved in 1 week. 

In 142 adult patients who took aripiprazole (mean final daily dose 16 mg, 0.20 mg/kg) for psychotic, major affective, or other disorders, adverse effects occurred in 16, were three times more likely among women, and most often involved moderate behavioral activation or nausea, with no new episodes of mania (4). 

Five patients (three women aged 30, 32, and 41 years and two men aged 36 and 56 years), had serious adverse effects developed after starting to take aripiprazole. There was agitation, akathisia, insomnia, and dysphoria three made suicide attempts and two had suicidal thoughts (10). 

Infants of women who choose to breast feed while on aripiprazole should be monitored for possible adverse effects... 

Atypical antipsychotics such as aripiprazole, olanzapine, que-tiapine, risperidone, and ziprasidone are effective as monotherapy or adjunctive therapy with lithium and valproate in the treatment of acute mania. Some antipsychotics have the potential to cause adverse effects such as extrapyramidal reactions, sedation, depression, emotional blunting, sexual dysfunction, weight gain, and orthostatic hypotension. Prophylactic use of antipsychotics may be needed for some patients with recurrent mania or mixed states, but the risks versus benefits must be weighed because of long-term adverse effects (e.g., obesity, type 2 diabetes, hyperlipidemia, hyperprolactinemia, cardiac disease, and tardive dyskinesia). ... 

Newer drugs (e.g., clozapine, risperidone, and olanzapine) act as antagonists at 5KT2 receptors and j seem to have fewer adverse effects. Aripiprazole is a D2 partial agonist... 

Fluoxetine and probably paroxetine may cause clinically significant increases in aripiprazole levels. The concurrent use of aripiprazole with SSRIs or venlafaxine has led to adverse effects such as the neuroleptic malignant syndrome and extrapyramidal symptoms. 

The concurrent use of aripiprazole and SSRIs can be useful, but it is important to remember to adjust the dose if paroxetine or fluoxetine are started or stopped, and be aware that, rarely, adverse effects such as extrapyramidal symptoms and the neuroleptic malignant syndrome may develop. 

In a 12-week, multicenter, randomized, double-blind, placebo-controlled trial of aripiprazole in the treatment of alcoholism in 295 subjects, aripiprazole produced more positive subjective effects and less overall severity of alcohol dependence than placebo, although there was no difference between aripiprazole and placebo on the primary end-point, possibly because of dose-related attrition (treatment was started at 2 mg/day and titrated to a maximum of 30 mg/day at day 28). Withdrawals (40% versus 27%) and treatment-related adverse effects (83% versus 64%) were more common with aripiprazole. The most common treatment-related adverse events that differed significantly between aripiprazole and placebo were fatigue, insomnia, restlessness, somnolence, anxiety, and altered attention serious adverse reactions attributed to aripiprazole were chest pain, cellulitis, migraine, and thrombosis extrapyramidal adverse reactions attributed... 

The most common side effects associated with aripiprazole include headache, nausea, dyspepsia, agitation, anxiety, insomnia, somnolence, and akathisia. Dose-related adverse events include somnolence and akathisia. Early clinical experience indicates that akathisia may be avoided by starting the medication at doses lower than 10 mg and increasing the dose slowly. Aripiprazole is not associated with significant sedation, anticholinergic side effects, weight gain, or cardiovascular side effects (Petrie et al. 1997). 

The term neuroleptic is often applied to drngs that have relatively prominent experimental and clinical evidence of antagonism of D2-dopamine-receptor activity, with substantial risk of adverse extrapyramidal nenrological effects and inaeased release of prolactin. The term atypical antipsychotic is applied to agents that are associated with snbstantially lower risks of snch extrapyramidal effects. Representative examples inclnde aripiprazole, clozapine, quetiapine, ziprasidone, and low doses of olanzapine and risperidone. 

Adverse Neurological Effects Many neurological syndromes, particularly involving the extrapyramidal motor system, occur following the use of most antipsychotic drugs, especially with the high-potency D -receptor antagonists (tricyclic piperazines and butyrophenones). Acute adverse extrapyramidal effects are less likely with aripiprazole, clozapine, quetiapine, thioridazine, and ziprasidone, or low doses of olanzapine or risperidone. 

Aripiprazole for 8 weeks has been used in 24 patients with hyperprolactinemia induced by risperidone, amisulpride, or sulpiride [132 ]. Prolactin concentrations fell from 77 to 18 ng/ml in those taking risperidone, from 145 to 128 in those taking amisulpride, and from 71 to 43 ng/ml in those taking sulpiride. Aripiprazole had no significant effect on metabolic measures or scales of movement adverse reactions. Nevertheless, it should be remembered that antipsychotic drug combinations are not approved for any indication. 

The effectiveness and cognitive effects of aripiprazole (mean dose 6.7 mg/day) have been assessed in a 6-week, open study in 23 children with attention-deficit/hyper-activity disorder [66 ]. There was overall significant improvement from baseline on attention-deficit/hyperactivity disorder and functional outcome measures. The most common adverse events were sedation (n = 18), headache (n = 11), nausea (n = 7), increased appetite (n = 6), musculoskeletal pain (n = 6), stomach ache (n = 5), hiccups (n = 4), and flu-like symptoms (n = 4). There was a significant increase in weight, with an increase from a mean of 37.6 kg at baseline to a mean of 39.6 kg at end of the study. 

Metamfetamine The results of a doubleblind study of potential interactions of intravenous metamfetamine (15 and 30 mg) with oral aripiprazole (15 mg) have been published [72 ]. The effects of aripiprazole on abstinence-related craving and cue-induced craving were also evaluated. Participants included non-treatment-seeking metamfetamine-dependent patients who took aripiprazole (n = 8) or placebo (n = 8) for 2 weeks. Aripiprazole had no effect on cue-induced metamfetamine craving, but was associated with increased craving independent of metamfetamine dose, euphoria, and amphetamine-like effects after metamfetamine. Aripiprazole reduced the increase in systolic blood pressure after metamfetamine, but it had no other effects on cardiovascular responses to metamfetamine. Aripiprazole did not alter the pharmacokinetics of metamfetamine. The adverse events tended to be equally distributed between the two groups, except for tremor (n = 4) and restlessness n = 3), which were more common in those who took aripiprazole. 

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