Aripiprazole

Aripiprazole, sold under the brand name Abilify among others, is an atypical antipsychotic. It is primarily used in the treatment of schizophrenia and bipolar disorder. Other uses include as an add-on treatment in major depressive disorder, tic disorders and irritability associated with autism. A Cochrane review found only poor quality evidence of effectiveness in treating schizophrenia. Additionally, since many people dropped out of the studies before they were completed, the strength of the conclusions was low. It is taken by mouth or injection into a muscle. Aripiprazole, sold under the brand name Abilify among others, is an atypical antipsychotic. It is primarily used in the treatment of schizophrenia and bipolar disorder. Other uses include as an add-on treatment in major depressive disorder, tic disorders and irritability associated with autism. A Cochrane review found only poor quality evidence of effectiveness in treating schizophrenia. Additionally, since many people dropped out of the studies before they were completed, the strength of the conclusions was low. It is taken by mouth or injection into a muscle. Common side effects include vomiting, constipation, sleepiness, dizziness, weight gain and movement disorders. Serious side effects may include neuroleptic malignant syndrome, tardive dyskinesia and anaphylaxis. It is not recommended for older people with dementia-related psychosis due to an increased risk of death. In pregnancy, there is evidence of possible harm to the baby. It is not recommended in women who are breastfeeding. It has not been very well studied in people less than 18 years old. The exact mode of action is not entirely clear but may involve effects on dopamine and serotonin. Aripiprazole was approved for medical use in the United States in 2002. It is available as a generic medication. In the United Kingdom, a month's supply costs the NHS about £2.75 as of 2019. In the United States, the wholesale cost of this amount is 10 USD. In 2016, it was the 131st-most prescribed medication in the United States, with more than 5 million prescriptions. Aripiprazole was discovered in 1988 by scientists at Japanese firm Otsuka Pharmaceutical. Aripiprazole is primarily used for the treatment of schizophrenia or bipolar disorder. The 2016 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 might have a role in treatment as an alternative to other depot formulations of second generation antipyschotics for people who have trouble taking medication as directed or who prefer it. A 2014 Cochrane review comparing aripiprazole and other atypical antipsychotics found that it is 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 for the prevention of relapse. A 2013 Lancet review found that it is in the middle range of 15 antipsychotics for effectiveness, approximately as effective as haloperidol and quetiapine and slightly more effective than ziprasidone, chlorpromazine, and asenapine, with better tolerability compared to the other antipsychotic drugs (4th best for weight gain, 5th best for extrapyramidal symptoms, best for prolactin elevation, 2nd best for QTc prolongation, and 5th best for sedation). The authors concluded that for acute psychotic episodes aripiprazole results in benefits in some aspects of the condition. In 2013 the World Federation of Societies for Biological Psychiatry recommended aripiprazole for the 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)'.