Aripiprazole is primarily used for the treatment of
schizophrenia or
bipolar disorder.
Schizophrenia The 2016
National Institute for Health and Care Excellence (NICE) guidance for treating psychosis and schizophrenia in children and young people recommended aripiprazole as a second-line treatment after
risperidone for people between 15 and 17 who are having an acute exacerbation or recurrence of psychosis or schizophrenia. A 2014 NICE review of the depot formulation of the drug found that it may have a role in treatment as an alternative to other depot formulations of second-generation antipsychotics for people who have trouble taking medication as directed or who prefer it. A 2014
Cochrane review comparing aripiprazole and other atypical antipsychotics found it difficult to determine differences as data quality is poor. A 2011 Cochrane review comparing aripiprazole with placebo concluded that high dropout rates in
clinical trials, and a lack of outcome data regarding general functioning, behavior, mortality, economic outcomes, or
cognitive functioning make it difficult to definitively conclude that aripiprazole is useful in preventing
relapse. This review found only low-quality evidence of effectiveness in treating schizophrenia. and slightly more effective than
ziprasidone,
chlorpromazine, or
asenapine, with better tolerability compared to the other antipsychotic drugs (4th best for reducing weight gain, 5th best for reducing
extrapyramidal symptoms, the best for reducing
prolactin levels, 2nd best for prolongated
QTc interval, and 5th best for sedative symptoms). The authors concluded that for acute psychotic episodes, aripiprazole results in benefits in some aspects of the condition. It lowers prolactin levels. In cases of
hyperprolactinaemia caused by other antipsychotics, the addition of or switch to aripiprazole is used to lower prolactin levels. Aripiprazole is recommended as the initial treatment for schizophrenia according to the INTEGRATE consensus international guidelines. In 2013 the World Federation of Societies for Biological Psychiatry recommended aripiprazole for treatment of acute exacerbations of schizophrenia as a Grade 1 recommendation and evidence level A. The British Association for Psychopharmacology similarly recommends that all persons presenting with psychosis receive treatment with an antipsychotic and that such treatment should continue for at least 1–2 years, as "There is no doubt that antipsychotic discontinuation is strongly associated with relapse during this period". The guideline further notes that "Established schizophrenia requires continued
maintenance with doses of antipsychotic medication within the recommended range (Evidence level A)". The British Association for Psychopharmacology Used as maintenance therapy, it is useful for the prevention of manic episodes but is not for
bipolar depression. Thus, it is often used in combination with an additional
mood stabilizer; however, co-administration with a mood stabilizer increases the risk of extrapyramidal side effects. In September 2014, aripiprazole had a UK
marketing authorization for up to 12 weeks of treatment for moderate to severe manic episodes in bipolar I disorder in young people aged 13 and older. Aripiprazole in doses of 2.5 mg can cause mania in those with bipolar disorder.
Depression Aripiprazole is an effective add-on treatment for major depressive disorder but increases the risk of side effects such as weight gain and
movement disorders. The overall benefit is small to moderate and its use appears to improve neither
quality of life nor functioning. and lesser interactions with
sertraline,
escitalopram,
citalopram and
fluvoxamine.
CYP2D6 inhibitors increase aripiprazole concentrations by 2–3 times.
Autism Short-term data (8 weeks) shows reduced irritability, hyperactivity, inappropriate speech, and
stereotypy, but no change in
lethargic behaviors. Adverse effects include weight gain, sleepiness, drooling, and
tremors. There is evidence supporting that it is effective, safe, and well-tolerated for this use per
systematic reviews and
meta-analyses.
Obsessive–compulsive disorder A 2014
systematic review and
meta-analysis concluded that add-on therapy with low-dose aripiprazole is an effective treatment for
obsessive–compulsive disorder (OCD) that does not improve with
selective serotonin reuptake inhibitors (SSRIs) alone. The conclusion was based on the results of two relatively small, short-term trials, each of which demonstrated improvements in symptoms. However, aripiprazole is cautiously recommended by a 2017 review on antipsychotics for OCD. Aripiprazole is not currently approved for the treatment of OCD and is instead used
off-label for this indication.
Available forms Aripiprazole is available in the form of
oral tablets, oral films, oral disintegrating tablets, oral solution, digital pills with sensors, and as a short-acting injectable for
intramuscular administration. It is also available as a
long-acting injectable,
aripiprazole lauroxil, a
lipophilic ester prodrug of aripiprazole designed to be given once per month, and as a once every two months long-acting injectable, under the brand name Abilify Asimtufii. == Contraindications ==