Aripiprazole

INTRODUCTION

Indications

Schizophrenia. Acute and maintenance therapy of manic and mixed episodes associated with bipolar disorder (as monotherapy or with lithium or valproate). Adjunct treatment of depression in adults. Agitation associated with schizophrenia or bipolar disorder.

Action

Psychotropic activity may be due to agonist activity at dopamine D₂ and serotonin 5-HT_1A receptors and antagonist activity at the 5-HT_2A receptor. Also has alpha₁-adrenergic blocking activity. Therapeutic Effects: Decreased manifestations of schizophrenia; Decreased mania in bipolar patients; Decreased symptoms of depression. Decreased agitation associated with schizophrenia or bipolar disorder.

Adverse Reactions/Side Effects

CNS: akathisia, confusion, depression, drowsiness, extrapyramidal reactions, fatigue, hostility, insomnia, lightheadedness, manic reactions, impaired cognitive function, nervousness, restlessness, seizures, suicidal thoughts, tardive dyskinesia. Resp: dyspnea. CV: bradycardia, chest pain, edema, hypertension, orthostatic hypotension, tachycardia. EENT: blurred vision, conjunctivitis, ear pain. GI: constipation, anorexia, ↑ salivation, nausea, vomiting, weight loss. GU: urinary incontinence. Hemat: anemia. Derm: dry skin, ecchymosis, skin ulcer, sweating. MS: muscle cramps, neck pain. Metab: hyperglycemia. Neuro: abnormal gait, tremor. Misc: NEUROLEPTIC MALIGNANT SYNDROME, ↓ heat regulation.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and report signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use.

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).

  • Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).

  • Akathisia (restlessness or desire to keep moving).

  • Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

• Be alert for suicidal thoughts and ideology. Notify physician immediately if patient exhibits signs of depression or other changes in mood and behavior such as nervousness, restlessness, hostility, confusion, or manic reactions.

• Assess levels of drowsiness or lightheadedness, especially in older adults. Determine if these side effects might impair gait, balance, and other functional activities.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, bruising, and pale skin. Notify physician immediately if these signs occur.

• Assess BP, and report a sustained increase in BP ...