Introduction
Aripiprazole is a medical agent that is approved by FDA for treatment of various mental health disorders. Aripiprazole is a generic name, whereas Abilify is a brand name, and the chemical structure is shown in Figure 1 below. As such, the treatment of the bipolar disease is guided by a skilled psychiatrist who may prescribe medication and continued treatment. According to Jauhar, & Young, (2019) there are a couple of drugs approved for Maintenance therapy in bipolar disorder by the US Food and Drug Administration (FDA). These drugs are; lithium, lamotrigine, aripiprazole, olanzapine, quetiapine (immediate-release), and ziprasidone. This paper critically discusses Aripiprazole, its characteristics and benefits.
Research
The discovery of aripiprazole happened in 1988 by the Japanese company Otsuka Pharmaceutical. The brands under which aripiprazole is also known are Aristada, Abilify Discmelt, Abilify Maintena and Abilify. FDA approves its use for treatment of schizophrenia, bipolar disorder, major depressive disorder, and autism spectrum disorders. Yet, there was a research on the effectiveness of aripiprazole for treatment of obsessive-compulsive disorder (OCD). However, other medical agents such as risperidone are more effective, which is why aripiprazole is not approved by FDA for treatment of OCD (FDA, 2022b). In addition, there is a research on the effectiveness of aripiprazole in treatment of attention-deficit hyperactivity disorder (ADHD). However, the research lacked evidence on the correlation between the prescription of aripiprazole and change in ADHD symptoms. Instead, the patients that participated in the study experienced headaches, sedation, and weight gain. Hence, the research does not support of the aripiprazole use for attention-deficit hyperactivity disorder treatment.
Drug Classification
According to the drug classification, aripiprazole is considered an atypical antipsychotic or second generation antipsychotic.
Mechanism of Action
Aripiprazole acts on mesolimbic and mesocortical dopamine pathways as a partial agonist. In other words, it activates the dopamine D2 and D3 receptors and produces a fraction of the response as compared to a full agonist such as dopamine. This is an appropriate solution to schizophrenia treatment as it modulates neurotransmission in dopaminergic pathways without causing overreaction, which may trigger hallucinations or delusions. Besides, aripiprazole acts as a partial agonist of the serotonin 5-HT1a and 5HT2a receptors (Ribeiro et al., 2018).
Pharmacokinetics
In terms of pharmacokinetics, aripiprazole has an elimination half-life of approximately 75 hours. Half-life is a pharmacokinetics concept that refers to the period of time in which the concentration of the substance or a drug in the plasma decreases to a more that 50% rate. This is important term as it points to the way the body processes the medical agents and how it eliminates it.
Pharmacodynamics
In the case of pharmacodynamics, Aripiprazole is antipsychotic substance belonging to an atypical category. It is stated that “it acts as a partial agonist of dopamine D2 receptors (DRD2) [Articles:14998222, 15019558]. Aripiprazole is also an antagonist at serotonin 2A receptors (HTR2A) and an agonist at serotonin 1A receptors (HTR1A)” (PharmGKB, 2021, para. 2).
Dosing and Administration
Appropriate dosing, administration route, and any considerations for dosing alterations. The medical agent is mainly administrated orally by consuming pills of various dosages. Dosing are prescribed accordingly with the diagnosis and the tolerance to the drug. As such, for schizophrenia patients, the beginners dose is 10 or 15mg once a day. The supporting dosage of aripiprazole is 15 mg per day (Preda & Shapiro, 2018). The clinical studies show the effectiveness of the medical agents in 10-30 mg per day. For patients with bipolar disorder manic episodes, the administration of the dosage starts with 15 mg and can be up to 30 mg per pay. The changes in dosage can be made only after 24 hour interval.
Considerations of Use and Dosing in Specific Specialty Populations
For the patients younger than 18 years old, the aripiprazole may be prescribed, but the studies on the topic are limited as well as for the topic of dosage change for elderly patients over 65 years old. However, elderly patients with dementia are not recommended for aripiprazole Intake due to increased risk of lethal outcome. The potential harm to the baby is noticed in pregnant women who take aripiprazole and it is not recommended during breastfeeding.
Half-Life
Half-life refers to the time needed for a substance amount to decrease by half. It is important since one needs to know how long a drug is active in the body. Aripiprazole’s half-life is around 75 hours, which means its concentration in the body will lower by 50% in 75 hours (FDA, 2022a).
Side Effects/Adverse Reaction Potentials
Aripiprazole may be associated with a number of adverse reactions and side effects. As such, the most common of them are vomiting, constipation, sleepiness, dizziness, weight gain and movement disorders. Some cases also report headaches or serious side effects such as neuroleptic malignant syndrome, tardive dyskinesia and anaphylaxis.
Contraindications for Use Including Significant Drug to Drug Interactions
Generally, aripiprazole interacts with antidepressants such as Prozac, Paxil, and itraconazole in a way that enhance aripiprazole’s effect. On the contrary, carbamazepine (Tegretol) and rifampin (Rifadin) decrease the effect of aripiprazole. Patients with diabetes mellitus who take aripiprazole should regularly monitor their blood glucose as its levels may increase.
Overdose Considerations
The effects of the aripiprazole overdose include the depression of the central nervous system, which leads to sedation or coma. No deaths associated with aripiprazole overdose were reported.
Diagnostics and Labs Monitoring
Aripiprazole’s diagnostics and lab monitoring is conducted through blood and urine tests.
Comorbidities Considerations
Comorbidity considerations include obesity, diabetes, Alzheimer’s disease, suicidality, low levels of WBC.
Legal and Ethical Considerations
There are no notable legal and ethical considerations as long as the drug is taken as prescribed.
Pertinent Patient Education Considerations
The patients should be educated on the possible side-effects and the correct dosage and intake order of aripiprazole, and should consult with their healthcare provider on the possible comorbidities or risks.
References
FDA. (2022a). Abilify[PDF document].
FDA. (2022b).Regulations: Good clinical practice and clinical trials.
Jauhar, S., & Young, A. H. (2019). Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy.International Journal of Bipolar Disorders, 7(1), 1-9.
PharmGKB. (2021). Aripiprazole.
Preda, A., & Shapiro, B. B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia.Expert Opinion On Drug Safety, 19(12), 1529-1538.
Ribeiro, E. L. A., de Mendonça Lima, T., Vieira, M. E. B., Storpirtis, S., & Aguiar, P. M. (2018). Efficacy and safety of aripiprazole for the treatment of schizophrenia: An overview of systematic reviews.European Journal of Clinical Pharmacology, 74(10), 1215-1233.