3D Mood disorders
CENTRAL NERVOUS SYSTEM
Adults: 10–20mg IM as needed, max 40mg/day
(10mg every 2 hours; or 20mg every 4 hours); usual
max 3 days. Switch to oral form as soon as possible.
Children: Not recommended.
Contraindications: History of QT prolongation.
Congenital long QT syndrome. Recent acute MI.
Uncompensated heart failure. Concomitant drugs that
cause QT prolongation, including dofetilide, sotalol,
quinidine, other Class Ia and III antiarrhythmics,
mesoridazine, thioridazine, chlorpromazine, droperidol,
pimozide, sparfloxacin, gatifloxacin, moxifloxacin,
halofantrine, mefloquine, pentamidine, arsenic trioxide,
levomethadyl, dolasetron, probucol, tacrolimus.
Warnings/Precautions: Concomitant use
of oral and IM forms: not recommended. Renal
(IM form) or hepatic impairment (both forms).
Discontinue if QTc ;500 msec persists, neuroleptic
malignant syndrome, or unexplained rash occurs;
consider discontinuing if tardive dyskinesia occurs.
Conditions that increase risk of torsade de pointes
(eg, bradycardia, hypokalemia, hypomagnesemia).
Monitor potassium, magnesium, others if risk of
electrolyte disturbances (eg, diarrhea); correct
imbalance before starting. Avoid in significant
cardiovascular disease (eg, arrhythmias). Evaluate
cardiac function if symptoms of torsade de pointes
occur (eg, dizziness, palpitations, syncope). Cardio- or
cerebrovascular disease. Pre-existing low WBCs or
history of leukopenia/neutropenia; monitor CBCs
during 1st few months of treatment; discontinue if
WBCs decline. Diabetes; monitor for hyperglycemia.
Risk of hypotension or seizures. History of breast
cancer. Dysphagia. Exposure to extreme heat.
Reevaluate periodically. Write ; for smallest practical
amount. Elderly (not for dementia-related psychosis).
Neonates: risk of extrapyramidal and/or withdrawal
symptoms post delivery (due to exposure during
3rd-trimester pregnancy). Labor & delivery. Pregnancy
(Cat.C). Nursing mothers: not recommended.
Interactions: See Contraindications. May potentiate
CNS drugs, antihypertensives. Antagonizes levodopa,
dopamine agonists. Extent of absorption and/or
plasma levels may be affected by CYP3A4 inducers
(eg, carbamazepine) or inhibitors (eg, ketoconazole).
Correct hypokalemia, hypomagnesemia due to
diuretics.
Adverse reactions: Somnolence, extrapyramidal
syndrome, respiratory disorder, GI upset, rash,
dystonia, tachycardia, myalgia, akathisia, asthenia,
postural hypotension, QTc prolongation, headache,
weight gain, inj site reactions; rare: priapism.
How supplied: Caps– 60; Inj (single-use vials)– 1
ADVERSE REACTIONS
Those adverse reactions listed within
product monographs represent the
potential for adverse effects based upon
the active ingredient(s) and/or the drug
class. It is not meant to be an inclusive
list of responses.
;ARIPIPRAZOLE
ABILIFY Bristol-Myers Squibb and Otsuka
Aripiprazole 2mg, 5mg, 10mg, 15mg, 20mg, 30mg;
tabs.
; Also: Aripiprazole
ABILIFY ORAL SOLUTION
Aripiprazole 1mg/mL; orange cream flavor; contains
parabens.
; Also: Aripiprazole
ABILIFY DISCMELT
Aripiprazole 10mg, 15mg; oral disintegrating tabs;
vanilla flavor; contains phenylalanine.
Indications: Acute and maintenance treatment
of manic or mixed episodes in bipolar disorder as
monotherapy; or as an adjunct to lithium or valproate.
Adjunct to antidepressants for major depressive
disorder. Irritability associated with autistic disorder.
Adults: Tabs and soln may be interchanged on a
mg–to–mg basis up to 25mg; 30mg as tablet is
equivalent to 25mg oral soln. Discmelt: Dissolve on
tongue; take without liquids. Bipolar disorder: initially
15mg once daily; may increase to max 30mg/day;
maintenance: 15mg/day or 30mg/day (see literature
for duration of therapy). Adjunct to major depressive
disorder: initially 2–5mg/day; may adjust by 5mg/day
increments at intervals of ;
1 week; usual range:
2–15mg/day. Reduce aripiprazole dose by at least ½
with CYP3A4 inhibitors or CYP2D6 inhibitors. Double
aripiprazole dose (max 30mg/day) with CYP3A4
inducers. Adjust dose to normal range when these
drugs are withdrawn.
Children: ;10yrs: not recommended. 10–17yrs:
Bipolar disorder: initially 2mg/day, then increase to
5mg/day after 2 days, then increase to target dose of
10mg/day after 2 days. Subsequent dose increases
may be adjusted by increments of 5mg/day; max
30mg/day. Maintenance: continue at lowest dose
to maintain remission; see literature. Irritability
w. autistic disorder: 6–17yrs: initially 2mg/day, then
increase to 5mg/day; adjust dose by 5mg/day at ;
1
week intervals; usual range 5–15mg/day.
; Also: Aripiprazole
ABILIFY INJECTION
Aripiprazole 7.5mg/mL; soln for IM use only.
Indications: Treatment of agitation associated with
acute manic or mixed episodes in bipolar disorder.
Adults: 9.75mg IM, if 2nd dose is needed, may
repeat after 2 hours; max 30mg/day. Switch to oral
form as soon as possible. Reduce aripiprazole dose
by at least ½ with CYP3A4 inhibitors or CYP2D6
inhibitors. Double aripiprazole dose (max 30mg/day)
with CYP3A4 inducers. Adjust dose to normal range
when these drugs are withdrawn.
Children: Not recommended.
Warnings/Precautions: Cardio- or cerebrovascular
disease. Risk of hypotension, aspiration pneumonia,
seizures, or diabetes (do baseline fasting blood
