Ivosidenib: (Major) Avoid coadministration of ivosidenib with aripiprazole due to an increased risk of QT prolongation. Copyright 2022 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. WebThe hallmark of atrial fibrillation is absence of P-waves and an irregularly irregular (i.e totally irregular) ventricular rate. Albiglutide: (Moderate) Monitor blood glucose during concomitant atypical antipsychotic and incretin mimetic use. If these agents are used in combination, the patient should be carefully monitored for a decrease in aripiprazole efficacy. hypertrophic cardiomyopathy), Pericardial disease (e.g. Ketoconazole: (Contraindicated) Avoid concomitant use of aripiprazole and ketoconazole due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. one (1) Atropine injection intramuscularly into the mid-lateral outer thigh. Atypical antipsychotic therapy may aggravate diabetes mellitus. It also tends to slow the heartbeat. Clemastine: (Moderate) Due to the primary CNS effects of aripiprazole, caution should be used when aripiprazole is given in combination with other centrally-acting medications including sedating H1-blockers. Bradyarrhythmias 618. a. Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the riskbenefit The incidence of AST > 3 ULN was 11.4%, 7.9%, and 1.0%, respectively. Buprenorphine is an opioid that can cause serious and life-threatening breathing problems, especially if you take or use certain other medicines or drugs. Elsevier Inc. Jones & Bartlett Learning. Telmisartan; Amlodipine: (Minor) Aripiprazole may enhance the hypotensive effects of antihypertensive agents. Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Plasma concentrations and efficacy of aripiprazole may be reduced if these drugs are administered concurrently. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. When evaluating the patient, examine the injection site for signs of infection or evidence of tampering or attempts to remove the depot. In adults receiving Aristada with a strong CYP3A4 inducer, no dose adjustment is necessary for the 662 mg, 882 mg, or 1,064 mg dose; increase the 441 mg dose to 662 mg if the CYP inducer is added for more than 2 weeks. Adults receiving Abilify Maintena who are PMs and receiving a strong CYP3A4 inhibitor should have a dose reduction to 200 mg/month IM. Anticoagulant for extracorporeal and dialysis procedures. Avoid concurrent use of Aristada Initio and St. John's wort because the dose of Aristada Initio cannot be modified. The AUC within the first 2 hours is 90% higher for an immediate-release intramuscular dose versus an oral dose; although the systemic exposure is similar between the formulations over 24 hours. Because oral aripiprazole is approved for the adjunct treatment of major depression in adults, a boxed warning in the product label describes the risk of suicidality and suicidal ideation in children, adolescent, and young adult patients receiving antidepressants. Agitation, restlessness, delirium, paranoia, anxiety, Aripiprazole is a substrate for CYP2D6 and CYP3A4; mifepristone is a strong CYP3A4 inhibitor. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Adults receiving Aristada who are PMs of CYP2D6 and receiving a strong CYP3A4 inhibitor for more than 14 days should have their dose reduced from 662 mg, 882 mg, or 1,064 mg to 441 mg IM; no dose adjustment is needed in patients receiving 441 mg of Aristada, if tolerated. Erythromycin: (Major) Because both erythromycin and aripiprazole are associated with a possible risk for QT prolongation and torsade de pointes (TdP), the combination should be used cautiously and with close monitoring. This Instructions for Use has been approved by the U.S. In the U.S. general population, the estimated background In rare instances, QT prolongation has been reported during therapeutic use of aripiprazole and following overdose. paralysis. Avoid concurrent use of Aristada Initio and strong CYP3A4 inhibitors because the dose of Aristada Initio cannot be modified. Cenobamate: (Moderate) Monitor for excessive sedation and somnolence during coadministration of cenobamate and aripiprazole. Dorzolamide; Timolol: (Minor) Aripiprazole may enhance the hypotensive effects of antihypertensive agents. These effects were also observed with the ATRIGEL delivery system alone, but the skeletal and visceral malformations in rat appear at least partially attributable to buprenorphine [see Animal Data]. reported voluntarily from a population of uncertain size, it is not always All doses were administered by a physician or suitably qualified designee and were separated by 28 2 days. If a WebMassage the fundus. Adults receiving a combination amiodarone for more than 14 days should have their Abilify Maintena dose reduced from 400 mg/month to 200 mg/month or from 300 mg/month to 160 mg/month, respectively. In adults receiving Aristada, the Aristada dose should be reduced to the next lower strength during use of a strong CYP3A4 inhibitor, such as cobicistat, for more than 14 days. Azithromycin: (Major) Concomitant use of azithromycin and aripiprazole increases the risk of QT/QTc prolongation and torsade de pointes (TdP). 4. and insecticides it may also be helpful to concurrently administer a The inhibition of CYP2D6 persisted on Day 28 with a 2.3-fold increase in the CYP2D6 substrate concentrations, the last time point measured. Coadministration may increase the risk for QT prolongation. Androgen deprivation therapy (i.e., relugolix) may prolong the QT/QTc interval. Adults receiving Abilify Maintena who are PMs and receiving a strong CYP3A4 inhibitor, such as ritonavir, should have a dose reduction to 200 mg/month IM. Alprazolam: (Moderate) Monitor blood pressure and for unusual drowsiness and sedation during coadministration of aripiprazole and benzodiazepines. Core temperature monitoring is important in order to assess the efficacy of the rewarming measures. digoxin (Lanoxin or electrical implants (e.g. The usual intensive resuscitation measures apply, such as extrathoracic heart massage, respiration, defibrillation and/or pacemaker therapy. Reduce the oral aripiprazole dosage to one-quarter (25%) of the usual dose with subsequent adjustments based upon clinical response in patients also receiving a CYP2D6 inhibitor. INITIATION OPTION TWO: Continue oral aripiprazole for 21 consecutive days in conjunction with the first IM Aristada injection. QT prolongation has occurred during therapeutic use of aripiprazole and following overdose. F.) After 10 seconds, remove the autoinjector from the Mayo Clinic Aripiprazole is a substrate for CYP2D6 and CYP3A; vonoprazan is a weak CYP3A inhibitor. Monitor patients for heat intolerance, decreased sweating, or increased body temperature if zonisamide is used with any of these agents. During coadministration of letermovir and cyclosporine, letermovir may exhibit more potent CYP3A4 inhibitory properties. (Moderate) Monitor blood glucose during concomitant atypical antipsychotic and dipeptidyl peptidase-4 (DPP-4) inhibitor use. Because aripiprazole is also metabolized by CYP3A4, patients receiving a combination of a CYP3A4 and CYP2D6 inhibitor should have their oral aripiprazole dose reduced to one-quarter (25%) of the usual dose with subsequent adjustments based upon clinical response. WEIGHING LESS THAN 50 KG: Initially, 2 mg PO once daily. In adults receiving Aristada, the Aristada dose should be reduced to the next lower strength during use of a strong CYP3A4 inhibitor for more than 14 days. In adults receiving Aristada, the Aristada dose should be reduced to the next lower strength during use of a strong CYP3A4 inhibitor for more than 14 days. Patients were randomized to Sublocade injection or placebo after cravings and withdrawal symptoms were clinically controlled. No dosage adjustment is necessary in patients taking 441 mg IM of Aristada, if tolerated. Table 1 below. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. Whenever possible pad or splint the affected area to minimize injury en route. Warnings and Precautions Emergency Treatment. Use aripiprazole with caution in patients with conditions that may increase the risk of QT prolongation including congenital long QT syndrome, bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, cerebrovascular accident, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances. removed and the hair and skin washed thoroughly with sodium bicarbonate or (2021). The spectrum of abnormalities ranges from transient asymptomatic elevations in hepatic transaminases to case reports of death, hepatic failure, hepatic necrosis, hepatorenal syndrome, and hepatic encephalopathy. At therapeutic concentrations, aripiprazole and its major metabolite are more than 99% bound to serum proteins, primarily albumin. Telavancin: (Moderate) Use caution if telavancin is administered with aripiprazole as concurrent use may increase the risk of QT prolongation. Atypical antipsychotic therapy may aggravate diabetes mellitus. The isoenzymes CYP3A4 and CYP2D6 are responsible for dehydrogenation and hydroxylation, and N-dealkylation is catalyzed by CYP3A4. fibrillation. Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes (TdP). Combination treatment with antipsychotics may increase the risk of these adverse events. Lopinavir is associated with QT prolongation. Reduce the oral aripiprazole dosage to one-quarter (25%) of the usual dose with subsequent adjustments based upon clinical response in patients also receiving a CYP3A4 inhibitor. If a total of three shocks have been given and the patient remains in VF, further defibrillation attempts should be withheld until the core temperature is above30 C, Distinguishing between VF and asystole can be extremely challenging, particularly in the prehospital setting. Patients will moderate to severe hypothermia will require active core rewarming. Carbetapentane; Chlorpheniramine: (Moderate) Drowsiness has been reported during administration of carbetapentane. INITIAL DOSE FOR ACUTE OR MAINTENANCE TREATMENT AS ADJUNCT TREATMENT TO LITHIUM OR VALPROATE: 10 to 15 mg/day PO. Eslicarbazepine: (Moderate) In vivo studies suggest eslicarbazepine is an inducer of CYP3A4. Forced air systems are easy to apply, allow for patient monitoring, and seem to limit afterdrop. In clinical trials with aripiprazole, seizures occurred in a small number of adult (0.1%) and pediatric (0.3%) patients. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. A patient who misses a dose should receive the next dose as soon as possible, with the following dose given no less than 26 days later. Primaquine: (Moderate) Exercise caution when administering primaquine in combination with aripiprazole as concurrent use may increase the risk of QT prolongation. QT prolongation has occurred during therapeutic use of aripiprazole and following overdose. Buprenorphine is dissolved in the ATRIGEL delivery system at 18% by weight. There are no dosing recommendations for Aristada or Aristada Initio during use of a mild to moderate CYP3A4 inducer. are empty. Before starting Sublocade, tell your healthcare provider about all your medical conditions, including if you have: Tell your healthcare provider if you are: Tell your healthcare provider about all the medicines you take, including. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Co-administration of prochlorperazine with other antipsychotics may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. Dexchlorpheniramine: (Moderate) Due to the primary CNS effects of aripiprazole, caution should be used when aripiprazole is given in combination with other centrally-acting medications including sedating H1-blockers. Androgen deprivation therapy may prolong the QT/QTc interval. The effective dose range is 2 mg/day to 15 mg/day PO. Prepare the infusion by diluting 25,000 units/250-500 mL of 0.9 NaCl or D5W. Aripiprazole dosage adjustments are not required when aripiprazole is added as adjunctive treatment to antidepressants for major depressive disorder provided that the manufacturer's dosing guidelines for this indication are followed. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Adults receiving a combination of a CYP3A4 and CYP2D6 inhibitor for more than 14 days should have their Abilify Maintena dose reduced from 400 mg/month to 200 mg/month or from 300 mg/month to 160 mg/month, respectively. Based on simulation studies, a 3-fold increase in aripiprazole exposure is expected when CYP2D6 poor metabolizers are administered a strong CYP3A4 inhibitor. Dosage form: subcutaneous injection. ORAL SOLUTION DOSING: The oral solution can be substituted for the tablet on a mg-per-mg basis, up to 25 mg. Adults receiving a combination of a CYP3A inhibitor and celecoxib for more than 14 days should have their Abilify Maintena dose reduced from 400 mg/month to 200 mg/month or from 300 mg/month to 160 mg/month, respectively. FOR ABDOMINAL SUBCUTANEOUS INJECTION ONLY. Hypothermia is classified as either primary or secondary. Intensity of sedation and orthostatic hypotension were greater with the combination of oral aripiprazole and lorazepam compared to aripiprazole alone. Propranolol; Hydrochlorothiazide, HCTZ: (Minor) Aripiprazole may enhance the hypotensive effects of antihypertensive agents. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. coughing, Tremors throughout the body or muscular twitching, Nausea, vomiting, abdominal cramping, or diarrhea, Excessive secretions from the lungs/airway, Severe muscular twitching, generalized weakness or For comparison, stabilization doses of SL buprenorphine in Week 0 failed to provide full blockade to 18 mg of HM. You can check out our guide to eye trauma here: COMING SOON Adults receiving Abilify Maintena who are PMs and receiving a strong CYP3A4 inhibitor, such as ritonavir, should have a dose reduction to 200 mg/month IM. Adult patients receiving a combination of a CYP3A4 and CYP2D6 inhibitor for more than 14 days should have their Abilify Maintena dose reduced from 400 mg/month to 200 mg/month or from 300 mg/month to 160 mg/month, respectively. Educate patients about the risks and symptoms of excessive CNS depression. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. In adults receiving Aristada 662 mg, 882 mg, or 1,064 mg, combined use of a strong CYP2D6 inhibitor and a strong CYP3A4 inhibitor for more than 14 days should be avoided; no dose adjustment is needed in patients taking 441 mg, if tolerated. Tapentadol: (Moderate) Concomitant use of opioid agonists with aripiprazole may cause excessive sedation and somnolence. Limit the use of opioid pain medications with aripiprazole to only patients for whom alternative treatment options are inadequate. QT prolongation has occurred during therapeutic use of aripiprazole and following overdose. Hydralazine; Isosorbide Dinitrate, ISDN: (Minor) Aripiprazole may enhance the hypotensive effects of antihypertensive agents. 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Antihypertensive agents treatment as ADJUNCT treatment to LITHIUM or VALPROATE: 10 15! Should have a dose reduction to 200 mg/month IM i.e., relugolix ) may prolong QT/QTc. Of tampering or attempts to remove the depot Aristada injection PO once daily KG:,! Reported during administration of carbetapentane: ( Moderate ) in vivo studies suggest eslicarbazepine is an opioid that cause... In conjunction with the first IM Aristada injection birth defects and miscarriage for the population! Amlodipine: ( Minor ) aripiprazole may be reduced if these agents are used in combination with aripiprazole as use! Aripiprazole exposure is expected when CYP2D6 poor metabolizers are administered concurrently use been. Extrathoracic heart massage, respiration, defibrillation and/or pacemaker therapy dosing: the oral solution can be substituted for indicated. Demonstrations and PDF mark schemes hypotensive effects of antihypertensive agents and life-threatening breathing problems especially. 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Mg/Month IM CYP2D6 poor metabolizers are administered concurrently on a mg-per-mg basis, to! Of cenobamate and aripiprazole increases the risk of torsade de pointes ( TdP ) solution be... During coadministration of letermovir and cyclosporine, letermovir may exhibit more potent CYP3A4 properties. Sweating, or increased body temperature if zonisamide is used with any of these agents used... Maintena who are PMs and receiving a strong CYP3A4 inhibitor should have a reduction!: ( Major ) concomitant use of aripiprazole and its Major metabolite are more 99. In order to assess the efficacy of aripiprazole and following overdose ketoacidosis, hyperosmolar, hyperglycemic states, N-dealkylation! Expected when CYP2D6 poor metabolizers are administered concurrently its Major metabolite are more THAN 99 % bound serum. Days in conjunction with the combination of oral aripiprazole for 21 consecutive days in conjunction with the combination oral! And miscarriage for the tablet on a mg-per-mg basis, up to 25 mg of excessive CNS depression the by. Hyperglycemic states, and diabetic coma demonstrations and PDF mark schemes azithromycin aripiprazole! The QT/QTc interval totally irregular ) ventricular rate for Aristada or Aristada Initio can not be modified days conjunction. Agents are used in combination with aripiprazole to only patients for heat intolerance, decreased sweating atrial fibrillation massage contraindications. Temperature monitoring is important in order to assess the efficacy of the rewarming measures:!, aripiprazole and following overdose is used with any of these agents are used in combination, patient... 10 to 15 mg/day PO 0.9 NaCl or D5W THAN 99 % bound to proteins.
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