aripiprazole

( a-rip-ip-pra,zol )
Abilify

schizophrenia, agitation, bipolar disorder, INTERACTIONS

Pharmacologic class: antipsychot- mania. alcohol: increased sedation. carba-
ic/neuroleptic. Therapeutic class: Data not mazepine: decreased effects of arip-
provided. Pregnancy risk category: C. iprazole. erythromycin, fluoxetine, ke-
INDICATIONS & DOSAGE
toconazole, quinidine, paroxetine: in-
PO adult.: 10-15mg/day, prn dosage may creased effects of aripiprazole, reduce
HOW SUPPLIED be increased to 30 mg/day, after 2wk; dose. famotidine, valproate: decreased
tabs: 2, 5, 10, 15, 20, 30mg. maintenance 15mg/day, periodically re- aripiprazole level. lithium: increased
inj: 9.75mg/1.3ml. assess. EPS. antipsychotics: increased EPS.
orally disintegrated tab: 10, 15mg. IM adult.: 9.75mg as a single dose, may
oral sol: 1mg/ml. CNS depressants: increased sedation.
start with a lower dose. CYP3A4/CYP2D6 inhibitors: increased
bipolar PO adult.: 30mg/day, may reduce
effects of aripiprazole, increase dose.
to 15mg PRN.
PHARMACOKINETICS CYP3A4/CYP2D6 inhibitors: increased
Absorption: unknown. Distribution: pro- effects of aripiprazole, increase dose. be-
tein binding 90%. Metabolism: liver, ex- ADVERSE REACTIONS tel palm, kava: increased EPS. cola tree,
tensively to major active metabolism. Ex- CNS: SEIZURES, NEUROLEPTIC MA- hops, nettle, nutmeg: increased neurolep-
cretion: unknown. LIGNANT SYNDROME, drowsiness, in- tic effect.
somnia, agitation, anxiety, headache, light- CONTRAINDICATIONS & PRECAU-
Route Onset Peak Duration
unknown unknown unknown unknown
headedness, akathisia, asthenia, tremor, TIONS
STROKE, SUICIDAL IDEATION. CV:
■ hypersensitivity, breastfeeding, seizure
TACHYCARDIA, orthostatic hypoten-
sion. EENT: blurred vision, rhinitis. GI: disorders.
■ children, geriatric, renal/cardiac/hepatic
PHARMACODYNAMICS nausea, constipation, vomiting, jaundice,
disease.
decreased excitement, hallucinations, weight gain. SKIN: rash. RESPIRATO-
delusions, paranoia, reoganization of RY: cough.
patterns of thought, speech. Used for

Assessment
■ Assess mental status before initial ad-
ministration. Check for swallowing of
PO meds, check for hoarding or giv-
ing of med to other pts. Monitor I&O ra-
tion, palpate bladder if urinary output is
low. Monitor bilirubin, CBC, liver func-
tion tests qmo. Assess affect, orientation,
LOC, reflexes, gait, coordination, sleep
pattern disturbances. Monitor BP stand-
ing and lying, also pulse, respirations,
take q4hr during initial treatment, estab-
lish baseline before starting treatment, re-
port drops of 30mmHg, watch for ECG
changes. Assess for dizzines, faintness,
palps, tachy on rising. Assess for EPS, in-
cluding akathisia(inability to sit still, no
patten to movements), tardive dyskine-
sia (bizarre movements of the jaw, mouth,
tongue, extremities), pseudoparkinsonism
(rigidity, tremors, pill rolling, shuffling
gait). Assess for neuroleptic malignant
syndrome, hyperthermia, increased CPK,
altered mental status, muscle rigidity. As-
sess skin turgor daily. Assess for constipa-
tion, urinary retention daily, if these occur,
increase bulk and water in diet.
Nursing Diagnosis
Evaluation
■ Knowledge, deficient (teaching).
■ Noncompliance (teaching).
■ Decreased in emotional excitement, hal-
■ Sensory perception, disturbed (uses). lucinations, delusions, paranoia, reorgani-
■ Thought processes, disturbed (uses). zation of patterns of thought and speech.
Planning & Implementation
■ Administer reduced dose in geriatric.
Decreased stimulus by dimming lights,
avoiding loud noises. Supervise ambula-
tion until patient is stabilized on meds. do
not involve in strenous exercise program
because fainting is possible, pt should not
stand still for a long time. store in tight,
light resistant container.
Patient Teaching
■ Advise pt that orthostatic hypotension
may occur and to rise from sitting or ly-
ing position gradually. Avoid hot tubs, hot
showers, tub baths, hypotension may ocur.
Avoid abrupt withdrawal of this product,
EPS may result, product should be with-
drawn slowly. Avoid OTC meds unless ap-
proved by MD because serious product in-
teractions may occur, avoid use with alco-
hol, CNS depressants, increased drowsi-
ness amy occur. Avoid hazardous activities
if drowsy or dizzy. Explain importance of
compliance with product regimen. Report
impaired vision, tremors, muscle twitch-
ing, urinary retention. Take extra precau-
tions to stay cool in hot weather, that heat
stroke may occur.