Aripiprazole SSRIs

Among these choices, bnspirone is preferred if the patient is also experiencing anxiety. If the patient is depressed and agitated, a SSRI should be tried first. Second line choices inclnde carbamazepine (Tegretol) or one of the atypical antipsychot-ics—ziprasidone (Geodon), risperidone (Risperdal), olanzapine (Zyprexa), quetiap-ine (Seroquel), or aripiprazole (Abilify) can be tried. If psychotic symptoms are present, one of the atypical antipsychotics should be tried first. 

ARIPIPRAZOLE, CLOZAPINE, HALOPERIDOL, PERPHENAZINE, RISPERIDONE, SERTINDOLE SSRIs Possible t plasma concentrations of these antipsychotics Inhibition of CYP2D6-mediated metabolism of these drugs. The clinical significance of this depends upon whether alternative pathways of metabolism of these substrates are also inhibited by co-adminis-tered drugs. The risk is theoretically greater with clozapine, haloperidol and olanzapine because their CYPl A2-mediated metabolism Is also Inhibited by SSRIs Warn patients to report T side-effects of these drugs, and consider reducing the dose of the antipsychotic... 

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. 

Drug-drug interactions SSRIs Aripiprazole had no effects on the pharmacokinetics of escitalopram, fluoxetine, paroxetine, sertraline, or venlafaxine either in healthy subjects ( =63) or in patients with major depressive disorder ( =498) [69. Point estimates for mean plasma concentration ratios indicated no substantial effect of aripiprazole on any antidepressant escitalopram 0.97 (0.91-1.03), fluoxetine 1.18 (1.05-1.32), paroxetine 0.73 (0.60-0.89), sertraline 0.96 (0.89-1.04), or venlafaxine 0.97 (0.89-1.05). 

Haloperidol (Haldol), risperidone (Risperdal), loxapine (Loxitane), ziprasidone (Geodon), quetiapine (Seroquel), clozapine (Clozaril), aripiprazole (Abilify), and thioridazine (Mellaril) are targeted in this solid phase extraction (SPE), liquid chromatography— tandem mass spectrometry (LC-MS/MS) method. Both 9-hydroxy-risperidone (Paliperiodone), an equipotent metabolite, and mesoridazine (Serentil) are also included in this method as they are pharmacologically active major metabolites of risperidone and thioridazine, respectively (4). Olanzapine (Zyprexa) can be quantified with this instrument method however, the extraction method is a liquid-liquid basic extraction (see Note 1). Due to the subsequent administration of antidepressants in conjunction with antipsychot-ics, this method can also be used for many of the common antidepressants, including the selective serotonin reuptake inhibitors (SSRIs) (see Note 2). 

Metabolism A 6-month, retrospective chart review compared patients on aripiprazole alone to aripiprazole and an SSRI (citalopram, fluoxetine, paroxetine, sertraline, venlafaxine) or aripiprazole and bupropion [92 ]. Only the combination of aripiprazole and an SSRI had statistically significant weight gain, thus it was hypothesised that in the presence of high serotonergic activity, aripiprazole acts as an antagonist at the 5-HT2c receptor. 

Drug-drug interactions The pharmacokinetics of aripiprazole, with and without coadministration of SSRIs, were compared according to CYP2D6 genotypes [93. Paroxetine decreased systemic clearance of aripiprazole by 58% and 23% in CYP2D6 extensive metaboUzers and intermediate metabolizers, respectively, while fluvoxamine had no effect... 

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