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Aripiprazole is a medication used to manage and treat schizophrenia, mania associated with bipolar I disorder, irritability associated with an autism spectrum disorder, disjunctive therapy in major depressive disorder, and Tourette syndrome. It is a third-generation antipsychotic medication. This activity reviews the indications, actions, and contraindications for aripiprazole as a valuable agent in managing the conditions mentioned above. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for the interprofessional team healthcare team members in the care of patients. Objectives: Identify FDA-approved and off-label indications for aripiprazole. Explain the mechanism of action of aripiprazole. Summarize the most common adverse effects associated with aripiprazole. Review the importance of communication and coordination amongst the interprofessional team to ensure appropriate monitoring of potential medication side effects in patients taking aripiprazole. Access free multiple choice questions on this topic.

According to FDA reports, there have been 76 cases of aripiprazole overdose. These include instances of both deliberate and accidental overdose in combination with other substances. There is currently no known antidote for aripiprazole overdose. However, early charcoal administration partially prevents the absorption of the drug if it is ingested orally, e.g., a tablet. Management of aripiprazole overdose should focus on supportive therapy. The clinician should obtain an EKG to identify any cardiac arrhythmias, such as QTc prolongation.[15]

Aripiprazole is usually prescribed by a psychiatrist, nurse practitioner, or primary care provider. Due to the array of possible side effects, it is essential to establish baseline measurements, including EKG, blood pressure, CMP, CBC, liver transaminase levels, BUN, and creatinine. Although extrapyramidal symptoms are less common in aripiprazole than in haloperidol, screening for and monitoring any developing EPS using AIMS (Abnormal Involuntary Movement Scale) is crucial. Interprofessional communication is essential in managing a patient on aripiprazole due to potential drug interactions and potentially fatal side effects such as QTc abnormalities, arrhythmias, agranulocytosis, and metabolic changes. Switching from one antipsychotic to another should be done gradually. For example, in the UK, aripiprazole would be started at a minimal clinically efficacious dose and titrated up as needed after two weeks, leaving the previous antipsychotic dose unchanged. Rapid or sudden withdrawal of prior medication may result in a decompensated presentation.[16] The pharmacist and nurse should encourage the patient to eat a healthy diet and exercise regularly since the drug is known to cause weight gain. Pharmacists must also verify that dosing is appropriate and check for drug interactions that may lead to concerns with dosing or adverse effects. Nursing should assist in follow-up monitoring, including assessing therapeutic effectiveness and noting potential signs of adverse effects. For example, regular monitoring of blood sugar and lipid concentrations is necessary as some patients may develop metabolic syndrome. Finally, to relieve the symptoms of schizophrenia, patients must be educated on the importance of adherence, which nursing can also counsel and evaluate. If the patient has a mental health provider involved in their case, then they should also have open communication with the healthcare team, so they can alert the prescriber to any concerns they may have for the patient's regimen. Aripiprazole requires an interprofessional team effort to be effective and minimize potential adverse effects, leading to better patient outcomes. [Level 5]