THERAPEUTICS

Brands

• Abilify, Abilify Discmelt, Abilify Maintena

Generic?

• No

Class

• Atypical antipsychotic

Commonly Prescribed for

(FDA approved in bold)

• Schizophrenia in adults and adolescents

• Bipolar I disorder (mixed and manic episodes) as monotherapy or adjunct to lithium or valproate

• Irritability associated with autistic disorder

• Adjunctive therapy for major depressive disorder

• Gilles de la Tourette syndrome (GTS; 6–18 years old)

• Agitation in patients with Alzheimer’s dementia (AD)

• Augmentation for refractory obsessivecompulsive disorder

• Anxiety disorder

• Insomnia

How the Drug Works

• It is a phenylpiperazine derivative that acts as partial agonist with high affinity towards 5-HT1A, 5-HT7, and D2-3 receptors, and moderate affinity towards 5-HT1D, 5-HT2C, and D4 receptors. As a partial agonist, it blocks receptors at high dopamine and serotonin levels, but activates receptors at low levels. It also exerts moderate antagonism on 5-HT2A/2B, H1, and α1,2- adrenergic receptors but with no effect on muscarinic receptors. Antagonism on D2 receptors relieves positive symptoms; antagonism on 5-HT2A relieves negative symptoms

How Long Until It Works

• Schizophrenia/bipolar: may be effective in days, more commonly takes weeks or months to determine best dose and achieve best clinical effect. Usually 4–6 weeks

• Agitation/insomnia: may be effective immediately

If It Works

• Continue to use at lowest required dose. Most patients with schizophrenia see a reduction in psychosis with neuroleptics. However, it may worsen psychosis in patients with Parkinson's disease (PD) or dementia with Lewy bodies (DLB)

If It Doesn't Work

• Increase dose

• Psychosis related to PD or DLB: clozapine is more efficacious for acute treatment only

• Insomnia: if no sedation occurs despite adequate dosing, change to another agent

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Patients with affective disorders, such as bipolar disorder, may respond to moodstabilizing AEDs, lithium, or benzodiazepines

Tests

• Prior to starting treatment and periodically during treatment, monitor weight, blood pressure, lipids, and fasting glucose due to risk of metabolic syndrome