Aripiprazole: Brands, Price & Uses in Bangladesh

Aripiprazole is an atypical antipsychotic (a dopamine partial agonist) with the following evidence-based indications:

Established / FDA-Approved Uses

• Schizophrenia - in adults and adolescents 13 years of age and older.
• Bipolar I disorder - treatment of acute manic and mixed episodes, as monotherapy or as an adjunct to lithium or valproate, in adults and pediatric patients 10 years of age and older; also used for maintenance treatment.
• Adjunctive treatment of major depressive disorder (MDD) in adults who have had an inadequate response to antidepressant therapy alone - Aripiprazole is added on to an existing antidepressant, not used as monotherapy for this indication.
• Irritability associated with autistic disorder - in pediatric patients 6 to 17 years of age (symptoms such as aggression, self-injury, and tantrums).
• Tourette's disorder - tic suppression in pediatric patients 6 to 18 years of age.
• Agitation associated with schizophrenia or bipolar I mania - short-acting intramuscular injection formulation, for acute agitation in adults.

Important Note

Aripiprazole is not approved for the treatment of dementia-related psychosis in elderly patients; see Precautions and Warnings for the associated mortality risk in this population.

Dosing of Aripiprazole is individualized by indication and titrated based on clinical response and tolerability. It may be taken with or without food.

Dose Adjustments

• With strong CYP2D6 inhibitors or CYP3A4 inhibitors (e.g., fluoxetine, paroxetine, ketoconazole): reduce Aripiprazole dose to about half the usual dose.
• With both a CYP2D6 and CYP3A4 inhibitor together, or in known CYP2D6 poor metabolizers: reduce dose to about a quarter of the usual dose.
• With strong CYP3A4 inducers (e.g., carbamazepine, rifampin): the Aripiprazole dose should be doubled over 1-2 weeks; when the inducer is stopped, the Aripiprazole dose should be reduced back.
• Renal impairment: no dosage adjustment generally required.
• Hepatic impairment: no dosage adjustment generally required for mild-to-moderate impairment; use with caution in severe impairment.

Always take Aripiprazole exactly as prescribed by your physician; do not change the dose or stop treatment abruptly without medical advice.

Side effects of Aripiprazole vary by indication, dose, and patient age. Common and serious effects include:

Common Side Effects

• Akathisia (a feeling of inner restlessness and an inability to sit still) - notably more frequent with Aripiprazole than with many other antipsychotics.
• Headache, insomnia or somnolence/sedation, nausea, vomiting, constipation.
• Anxiety, restlessness, tremor, dizziness, blurred vision.
• Weight gain (generally less pronounced than with some other atypical antipsychotics, but still clinically relevant).

Serious Side Effects (seek prompt medical attention)

• Metabolic changes: hyperglycemia, new-onset or worsening diabetes, and dyslipidemia (elevated cholesterol/triglycerides); periodic monitoring of blood glucose, weight, and lipids is recommended.
• Extrapyramidal symptoms (EPS): muscle stiffness, tremor, abnormal movements.
• Tardive dyskinesia: a potentially irreversible movement disorder that can develop with long-term use; risk increases with duration of treatment.
• Impulse control problems: compulsive or uncontrollable urges to gamble, eat, shop, or engage in sexual behavior have been reported and typically resolve after dose reduction or discontinuation.
• Neuroleptic malignant syndrome (NMS): a rare but life-threatening reaction presenting with high fever, muscle rigidity, altered mental status, and autonomic instability; requires immediate discontinuation and emergency treatment.
• Orthostatic hypotension, syncope, and, rarely, seizures and low white blood cell counts (leukopenia/neutropenia).
• Suicidal thoughts and behavior - see Precautions and Warnings.