Aripiprazole

Registered South African indications:

• Schizophrenia (inj, tab)
  - Treatment and maintenance of clinical improvement (tab)
  - Maintenance treatment in patients stabilised with oral aripiprazole (inj)
• Acute manic episodes associated with bipolar I disorder (tab)
• Prevention of recurrence of new manic episodes in patients who experienced predominantly manic episodes and who responded to aripiprazole treatment (tab)

Contraindications 

South African recommendations

• Hypersensitivity to the active ingredient or any of its excipients
• Children below 18 years

Recommendations in other jurisdictions

• Hypersensitivity to the active ingredient or any of its excipients

Cautions 

South African recommendations

• Pregnancy
• Breastfeeding
• Severe hepatic impairment (inj)
• Elderly 
  - Dementia-related psychosis
  - Psychosis associated with Alzheimer's disease
• Known cardiovascular disease
  - History of myocardial infarction
  - Ischaemic heart disease
  - Heart failure
  - Conduction abnormalities
• Cerebrovascular disease
• Hypotension or risk factors thereof
  - Dehydration
  - Hypovolemia
  - Treatment with antihypertensive medicinal agents
• Hypertension
  - Accelerated
  - Malignant
• Risk factors for venous thromboembolism
• Family history of QT prolongation (inj)
• History of seizure disorder or conditions associated with seizures
• Diabetes mellitus
  - Family history of diabetes
  - Risk factors for diabetes mellitus
• Thyroid disorder
• Pituitary adenoma
• Risk of aspiration pneumonia
• High risk for suicide
• High risk for falls
  - Eldery
  - Debilitated patients
• History of impulse control disorders
• Conditions which may contribute to elevation in core body temperature (tab)
  - Strenuous exercise
  - Exposure to extreme heat
  - Dehydration 
• Long-term exposure (tab)
• Obesity (inj)
• Acutely agitated or severely psychotic states (inj)
• Coadministration with agents with anticholinergic activity 
• Coadministration with stimulants for the treatment of attention deficient hyperactivity disorder (ADHD) (tab)
• Galactose intolerance e.g. galactosaemia (tab)
• Lapp lactase deficiency (tab)
• Glucose-galactose malabsorption (tab)
• May impair ability to drive and operate machinery 

Recommendations in other jurisdictions

• Pregnancy
• Breastfeeding
• Severe hepatic impairment
• Elderly 
  - Dementia-related psychosis
  - Psychosis associated with Alzheimer's disease
• Known cardiovascular disease
  - History of myocardial infarction
  - Ischaemic heart disease
  - Heart failure
  - Conduction abnormalities
• Cerebrovascular disease
• Hypotension or risk factors thereof
  - Dehydration
  - Hypovolemia
  - Treatment with antihypertensive medicinal agents
• Hypertension
  - Accelerated
  - Malignant
• Risk factors for venous thromboembolism
• Family history of QT prolongation
• History of seizure disorder or conditions associated with seizures
• Diabetes mellitus
  - Family history of diabetes
  - Risk factors for diabetes mellitus
• Obesity 
• Thyroid disorder
• Pituitary adenoma
• Risk of aspiration pneumonia
• History of impulse control disorders
• High risk for suicide
• High risk for falls
  - Eldery
  - Debilitated patients
• Acutely agitated or severely psychotic states (inj)
• Coadministration with stimulants for the treatment of attention deficient hyperactivity disorder (ADHD) (tab) 
• Galactose intolerance (tab) 
• Total lactase deficiency (tab) 
• Glucose-galactose malabsorption (tab) 
• May impair ability to drive and operate machinery 

Forms avail. in SA and covered in this monograph: tab, inj 

Dosages below include:

• South African registered indications and dosages
• Indications and dosages registered in other jurisdictions

South African registered indications and dosages

Schizophrenia 
- Treatment and maintenance of clinical improvement

• Oral (tab): Initial: 10-15mg, dly without regard to meals; Maintenance: 15mg, dly; Max: 30mg/24hrs

---

Aripiprazole is effective in a dose range of 10-30mg/day. Enhanced efficacy at doses higher than a daily dose of 15mg has not been demonstrated although individual patients may benefit from a higher dose 

---

- Maintenance treatment in patients stabilised with oral aripiprazole

• IM: 400mg; Followed by: Oral (tab): 10-20mg, dly for 14 consecutive days to maintain therapeutic aripiprazole concentrations during initiation of therapy; Maintenance: 400mg, monthly (no sooner than 26 days after the previous injection)

If there are adverse reactions with the 400mg dosage

• IM: 300mg, monthly (no sooner than 26 days after the previous injection)

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For IM use only. DO NOT administer IV or SC. Suspension should be injected slowly as a single injection into the gluteal or deltoid muscle. Care should be taken to avoid inadvertent injection into a blood vessel

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For patients who have never taken aripiprazole, tolerability with oral aripiprazole must occur prior to initiating treatment with aripiprazole IM

---

Titration of the dose for aripiprazole IM is not required

---

See additional prescribing points for dosing guidance regarding missed doses and use with concomitant medications 

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Acute manic episodes associated with bipolar I disorder
Prevention of recurrence of new manic episodes (Additional agent(s) may be required)
- As monotherapy or combination therapy in patients who experienced predominantly manic episodes and who responded to aripiprazole treatment

• Oral (tab): Initial: 15mg, dly without regard to meals; Max: 30mg/24hrs 

---

Adjustments of daily dosage, including dose reduction should be considered on the basis of clinical status

---

Indications and dosages registered in other jurisdictions

Schizophrenia

• Oral (tab): Initial: 10-15mg, dly without regard to meals; Maintenance: 15mg, dly; Max: 30mg/24hrs

---

Aripiprazole is effective in a dose range of 10-30mg/day. Enhanced efficacy at doses higher than a daily dose of 15mg has not been demonstrated although individual patients may benefit from a higher dose

---

- Maintenance treatment in patients stabilised with oral aripiprazole 

One injection start

• IM: First inj: 400mg; Followed by: Oral (tab): 10-20mg, dly for 14 consecutive days to maintain therapeutic aripiprazole concentrations during initiation of therapy; Maintenance: 400mg, monthly (no sooner than 26 days after the previous injection) 

Two injection start

• IM: First inj: 800mg, as 2 separate injections of 400mg at separate injection sites; Followed by: Oral (tab): 20mg, as a single dose; Maintenance: 400mg, monthly (no sooner than 26 days after the previous injection)

If there are adverse reactions with the 400mg dosage

• IM: 300mg, monthly (no sooner than 26 days after the previous injection)

---

For IM use only. DO NOT administer IV or SC. See additional prescribing points for administration instructions

---

For patients who have never taken aripiprazole, tolerability with oral aripiprazole must occur prior to initiating treatment with aripiprazole IM

---

Titration of the dose for aripiprazole IM is not required

---

Manic episodes in bipolar I disorder - moderate to severe
Prevention of a new manic episode in those who experienced predominantly manic episodes and whose manic episodes responded to aripiprazole treatment

• Oral (tab): Initial: 15mg, dly; Max: 30mg/24hrs 

---

Adjustments of daily dosage, including dose reduction should be considered on the basis of clinical status

---

See additional prescribing points for dosing guidance regarding missed doses and use with concomitant medications 

---

Orodispersible tablets or oral solution may be used as an alternative to tablets for patients who have difficulty swallowing tablet

Paed. forms avail. in SA and covered in this monograph: tab

Dosages below include:

• South African registered indications and dosages
• Indications and dosages registered in other jurisdictions

South African registered indications and dosages

Not registered for use in South Africa for children below 18 years

---

Indications and dosages registered in other jurisdictions

Schizophrenia

Younger than 15 years

• Not established for use

15 years and older

• Oral (tab): Initial: 2mg (using aripiprazole oral solution 1mg/ml) for 2 days; Then: Titrate to 5mg, dly for 2 days until maintenance dose of 10mg, dly is reached; Max: 30mg/24hrs 

---

To be taken without regard to meals

---

When appropriate, subsequent dose increases should be administered in 5mg increments without exceeding the maximum daily dose of 30mg 

---

Aripiprazole is effective in a dose range of 10-30mg/day. Enhanced efficacy at doses higher than a daily dose of 10mg has not been demonstrated although individual patients may benefit from a higher dose 

---

The safety and efficacy of aripiprazole IM in children and adolescents aged 0 to 17 years have not been established. No data are available

---

Manic episodes associated with bipolar I disorder - moderate to severe

Younger than 13 years

• Not recommended for use

13 years and older

• Oral (tab): Initial: 2mg (using aripiprazole oral solution 1mg/ml) for 2 days; Then: Titrate to 5mg, dly for 2 days until maintenance dose of 10mg, dly is reached; Max: 30mg/24hrs; Treatment duration: ≤12 weeks

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To be taken without regard to meals

---

Enhanced efficacy at doses higher than a daily dose of 10mg has not been demonstrated, and a daily dose of 30mg is associated with a substantially higher incidence of significant adverse reactions including extrapyramidal symptoms related events, somnolence, fatigue and weight gain. Doses higher than 10mg/day should therefore only be used in exceptional cases and with close clinical monitoring 

---

The safety and efficacy of aripiprazole IM in children and adolescents aged 0 to 17 years have not been established. No data are available

---

For irritability associated with autistic disorder, aripiprazole is not established for use in younger than 18 years

---

For use in tics associated with Tourette's disorder, aripiprazole is not established for use between 6-18 years, and no information is available for younger than 6 years 

Pregnancy

South African recommendations

• Caution; positive evidence for risk 
• Safety during pregnancy has not been established
• Congenital anomalies have been reported; however, causal relationship with aripiprazole could not be established. Animal studies could not exclude potential developmental toxicity (inj)
• Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during treatment
• Neonates exposed to antipsychotics (including aripiprazole) during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms that may vary in severity and duration following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, or feeding disorder. Consequently, newborns should be monitored carefully
• Prescribers need to be aware of the long-acting properties of aripiprazole IM

Recommendations in other jurisdictions

• Caution; positive evidence for risk
• There are no adequate and well-controlled trials of aripiprazole in pregnant women
• Congenital anomalies have been reported; however, causal relationship with aripiprazole could not be established. Animal studies could not exclude potential developmental toxicity
• Patients must be advised to notify their physician if they become pregnant or intend to become pregnant during treatment with aripiprazole
• Due to insufficient safety information in humans and concerns raised by animal reproductive studies, this medicinal product should not be used in pregnancy unless the expected benefit clearly justifies the potential risk to the foetus 
• Newborn infants exposed to antipsychotics (including aripiprazole) during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms that may vary in severity and duration following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, or feeding disorder. Consequently, newborn infants should be monitored carefully
• Prescribers need to be aware of the long-acting properties of aripiprazole IM

Breastfeeding

South African recommendations

• Caution; no information available (tab)
• Safety of use during breastfeeding has not been established (tab)
• Caution; not recommended  (inj) 
• Women using aripiprazole IM must not breastfeed their infants (inj)
• Aripiprazole is excreted in human breast milk

Recommendations in other jurisdictions

• Caution; not recommended 
• Aripiprazole/metabolites are excreted in human milk
• A decision must be made whether to discontinue breastfeeding or to discontinue/abstain from aripiprazole therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman

Fertility

• Aripiprazole did not impair fertility based on data from reproductive toxicity studies

Renal Impairment

• No dose adjustment recommended 

Hepatic Impairment

South African recommendations

• No dose adjustment recommended (tab)
• Mild to moderate: No dose adjustment recommended (inj) 
• Severe: Caution; no information available (inj)
  The data available are insufficient to establish recommendations. Oral formulation should be preferred

Recommendations in other jurisdictions

• Mild to moderate: No dose adjustment recommended 
• Severe: Caution; no information available 
  The data available are insufficient to establish recommendations. Oral formulation should be preferred
  Dosing should be managed cautiously. The maximum daily dose of 30mg should be used with caution (tab)

Elderly 

South African recommendations

• Caution; no dose adjustment recommended (tab)
  Lower starting dose should be considered when treating patients at higher risk of falls, such as the elderly
• Caution; no information available (inj)

Recommendations in other jurisdictions

• Caution; no information available 
  Lower starting dose should be considered when clinical factors warrant

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Akathisia
• Extrapyramidal disorder
• Tremor
• Headache
• Sedation
• Somnolence
• Dizziness
• Dyskinesia
  - Tardive dyskinesia
• Dystonia
  - Spasm of the neck muscles
  - Tightness of the throat
  - Difficulty swallowing
  - Difficulty breathing
  - Protrusion of the tongue
• Restless legs syndrome
• Parkinsonism
• Neuroleptic malignant syndrome
  - Hyperpyrexia
  - Muscle rigidity
  - Altered mental status
  - Evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia)
  - Increased creatine phosphokinase
  - Myoglobinuria (rhabdomyolysis)
  - Acute renal failure
• Grand mal seizures
• Serotonin syndrome
• Speech disorder
• Syncope
• Insomnia
• Anxiety
• Restlessness
• Depression
• Hypersexuality
• Suicidal ideation
• Suicide attempt
• Completed suicide
• Pathological gambling
• Impulse-control disorder
• Binge eating
• Compulsive shopping
• Poriomania
• Aggression
• Agitation
• Nervousness
• Fatigue
• Neonatal drug withdrawal syndrome
• Motor instability
• Affect lability (inj) 
• Apathy (inj)
• Dysphoria (inj) 
• Sleep disorder (inj)
• Bruxism (inj)
• Decreased libido (inj)
• Altered mood (inj)
• Movement disorder (inj) 
• Psychomotor hyperactivity (inj)
• Cogwheel rigidity (inj)
• Hypertonia (inj)
• Bradykinesia (inj)
• Drooling (inj)
• Parosmia (inj)
• Gait disturbance (inj)
• Sluggishness (inj)
• Panic reaction (inj)
• Psychotic disorder (inj)
• Hallucinations (inj)
• Delusion (inj)

Cardiovascular Disorders

• Tachycardia
• Sudden unexplained death
• Torsades de pointes
• Ventricular arrhythmia
• Cardiac arrest
• Bradycardia
• Orthostatic hypotension
• QT prolongation
• Hypertension
• Venous thromboembolism
  - Deep vein thrombosis
  - Pulmonary embolism 
• Chest pain
• Chest discomfort (inj)
• Ventricular extrasystoles (inj)
• Decreased electrocardiogram T wave amplitude (inj)
• Abnormal electrocardiogram (inj)
• Inversion of electrocardiogram T wave (inj)
• Increased heart rate (tab)

Respiratory Disorders

• Hiccups
• Aspiration pneumonia
• Laryngospasm
• Oropharyngeal spasm
• Cough (inj)

Gastrointestinal Disorders

• Constipation
• Dyspepsia
• Nausea and vomiting
• Salivary hypersecretion
• Dry mouth
• Dysphagia
• Diarrhoea
• Upper abdominal pain 
• Abdominal discomfort
  - Stomach discomfort (tab)
• Gastrooesophageal reflux disease (inj) 
• Frequent bowel movements (inj) 

Hepatobiliary Disorders

• Hepatic failure
• Hepatitis
• Jaundice
• Increased alanine aminotransferase
• Increased aspartate aminotransferase
• Increased gamma-glutamyl transferase
• Increased alkaline phosphatase
• Pancreatitis
• Abnormal hepatic function test (inj)
• Increased hepatic enzyme (inj) 
• Increased blood bilirubin (inj) 

Genitourinary Disorders

• Priapism
• Urinary incontinence
• Urinary retention
• Nephrolithiasis (inj)
• Glycosuria (inj)
• Erectile dysfunction (inj)
• Gynaecomastia (inj)
• Breast tenderness (inj)
• Vulvovaginal dryness (inj)

Endocrine and Metabolic Disorders

• Increase in serum prolactin
• Decrease in serum prolactin
• Diabetic hyperosmolar coma
• Diabetic ketoacidosis
• Hyperglycaemia
• Diabetes mellitus
• Hyponatremia
• Anorexia
• Decreased weight 
• Increased weight
• Fluctuation of blood glucose
  - Increased blood glucose
  - Decreased blood glucose (inj)
• Increased appetite (tab)
• Appetite disorder (inj) 
• Increased blood insulin
• Hypercholesterolaemia
• Decreased blood cholesterol (inj)
• Decreased blood triglycerides (inj)
• Hyperlipidaemia
• Hypertriglyceridaemia
• Galactorrhoea (inj)
• Thirst (inj)
• Increased waist circumference (inj)

Musculoskeletal Disorders

• Rhabdomyolysis
• Myalgia
• Musculoskeletal stiffness
• Increased creatine phosphokinase
• Muscle twitching
• Muscle rigidity
• Muscle spasms 
• Muscle tightness
• Pain in extremity (inj)
• Arthralgia (inj)
• Back pain (inj)
• Decreased joint range of motion (inj)
• Nuchal rigidity (inj)
• Trismus (inj)

Skin and Subcutaneous Tissue Disorders

• Rash
• Photosensitivity reaction
• Alopecia
• Hyperhidrosis
• Drug reaction with eosinophilia and systemic symptoms (DRESS)
• Acne (inj)
• Rosacea (inj)
• Eczema (inj)
• Skin induration (inj)
• Injection site pain (inj) 
• Injection site induration (inj)
• Injection site reactions (inj)
  - Erythema
  - Swelling
  - Discomfort
  - Pruritus

Immune, Blood and Lymphatic System Disorders

• Anaemia (inj)
• Leukopenia
• Neutropenia
• Thrombocytopenia
• Allergic reaction
  - Anaphylactic reaction
• Angioedema 
  - Swollen tongue
  - Tongue oedema 
  - Face oedema 
  - Pruritus
  - Urticaria
• Temperature regulation disorder
  - Hypothermia
  - Pyrexia
• Increased glycosylated haemoglobin
• Hypersensitivity
• Peripheral oedema
• Decreased neutrophil count
• Decreased white blood cell count

Sensory Disorders

• Blurred vision
• Diplopia
• Photophobia
• Oculogyric crisis
• Sensory instability 
• Dysgeusia (inj) 
• Eye pain (inj) 

• Antihypertensive agents
• Central nervous system agents
• QT prolonging agents
• Agents known to cause electrolyte imbalance
• CYP2D6 inhibitors (particularly strong inhibitors)
• Quinidine
• Fluoxetine
• Paroxetine
• Escitalopram
• CYP3A4 inhibitors (particularly strong inhibitors)
• Ketoconazole
• Itraconazole
• HIV protease inhibitors
• Diltiazem
• Strong CYP3A4 inducers
• Carbamazepine
• Rifampicin
• Rifabutin
• Phenytoin
• Phenobarbital
• Primidone
• Efavirenz
• Nevirapine
• Other serotonergic agents
• Selective serotonin reuptake inhibitors
• Serotonin-noradrenalin reuptake inhibitors

Other interactions

• Alcohol
• St John's wort

• Electrolytes
• Hepatic function
• Renal function
• Thyroid stimulating hormone
• Fasting blood glucose/ HbA1c
• Lipid profile
• Vital signs
• Weight
• Height
• Body mass index (BMI)

Specific cases may require

• Full blood count
• Prolactin
• Waist circumference

Additional observations

• Adherence
• Extrapyramidal symptoms
• Fall risk
• Mental status
• Metabolic syndrome history
  - Personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease
• Symptoms of hyperprolactinemia
  - Changes in menstruation
  - Libido
  - Gynaecomastia
  - Development of galactorrhoea
  - Erectile and ejaculatory function
• Tardive dyskinesia

Missed doses (inj)

If 2nd or 3rd dose is missed and time since last injection is:	Action
>4 weeks and <5 weeks	The injection should be administered as soon as possible and then the monthly injection schedule should be resumed
>5 weeks	Concomitant oral aripiprazole should be restarted for 14 days with next administered injection  Or two separate injections given at one time, along with a single dose of 20mg oral aripiprazole. Monthly injection schedule should then resume (International manufacturer recommendations)
If 4th or subsequent doses are missed (i.e. after attainment of steady state) and time since last injection is:	Action
>4 weeks and <6 weeks	The injection should be administered as soon as possible and then the monthly injection schedule should be resumed
>6 weeks	Concomitant oral aripiprazole should be restarted for 14 days with next administered injection and then resume monthly injection schedule Or two separate injections given at one time, along with a single dose of 20mg oral aripiprazole (International manufacturer recommendations)

Administration instructions (inj) 

• The suspension should be injected slowly as a single injection (doses must not be divided) into the gluteal or deltoid muscle. Care should be taken to avoid inadvertent injection into a blood vessel
• If initiating with the two injection start, inject into two different sites in two different muscles. Do not inject both injections concomitantly into the same deltoid or gluteal muscle. For known CYP2D6 poor metabolisers administer in either two separate deltoid muscles or one deltoid and one gluteal muscle. Do not inject into two gluteal muscles (Recommendations in other jurisdictions)

Known CYP2D6 poor metabolisers (inj)

• In patients who are known to be CYP2D6 poor metabolisers, the starting and maintenance dose should be 300mg. When used concomitantly with strong CYP3A4 inhibitors the dose should be reduced to 200mg
• One injection start: The starting dose should be 300mg aripiprazole and continue treatment with prescribed dose of oral aripiprazole per day for 14 consecutive days (Recommendations in other jurisdictions)
• Two injection start: The starting dose should be two separate injections of 300mg aripiprazole along with one single dose of the previous prescribed dose of oral aripiprazole (Recommendations in other jurisdictions) 

Known CYP2D6 poor metabolisers and concomitantly use a strong CYP3A4 inhibitor (inj) (Recommendations in other jurisdictions)

• One injection start: The starting dose should be reduced to 200mg and continue treatment with the prescribed dose of oral aripiprazole per day for 14 consecutive days 
• Two injection start is not to be used in patients who are known to be CYP2D6 poor metabolisers and concomitantly use a strong CYP3A4 inhibitor 

Dose adjustments due to coadministered medications

Oral

• When concomitant administration of strong CYP3A4 or CYP2D6 inhibitors with aripiprazole occurs, the aripiprazole dose should be reduced (e.g halved). When the CYP3A4 or CYP2D6 inhibitor is withdrawn from the combination therapy, aripiprazole dose should then be increased
• When concomitant administration of strong CYP3A4 inducers with aripiprazole occurs, the aripiprazole dose should be increased (e.g. doubled). When the CYP3A4 inducer is withdrawn from the combination therapy, the aripiprazole dose should then be reduced 

Injection

• Dose adjustments due to interactions with CYP2D6 and/or CYP3A4 inhibitors and/or CYP3A4 inducers: 
  - Dosage adjustments should be made in patients taking concomitant strong CYP3A4 inhibitors or strong CYP2D6 inhibitors for more than 14 days. If the CYP3A4 inhibitor or CYP2D6 inhibitor is withdrawn, the dosage may need to be increased to the previous dose 
  -  In case of adverse reactions despite dose adjustments of aripiprazole, the necessity of concomitant use of CYP2D6 or CYP3A4 inhibitor should be reassessed 
  - Coadministration of CYP3A4 inducers with aripiprazole should be avoided for more than 14 days because the blood levels of aripiprazole are decreased and may be below the effective levels 
• Dose adjustments of aripiprazole in patients who are taking concomitant strong CYP2D6 inhibitors, strong CYP3A4 inhibitors, and/or CYP3A4 inducers for more than 14 days:

Aripiprazole (inj) - 400mg

Coadministered medicine	Adjusted dose
Strong CYP2D6 or strong CYP3A4 inhibitors	300mg
Strong CYP2D6 and strong CYP3A4 inhibitors	200mg*
CYP3A4 inducers	Avoid use

Aripiprazole (inj) - 300mg

Coadministered medicine	Adjusted dose
Strong CYP2D6 or strong CYP3A4 inhibitors	200mg*
Strong CYP2D6 and strong CYP3A4 inhibitors	160mg*
CYP3A4 inducers	Avoid use

*200mg and 160mg can be achieved via adjustment of the injection volume only by using aripiprazole powder and solvent for prolonged-release suspension for injection

It has been proposed that aripiprazole's efficacy in schizophrenia and bipolar I disorder is mediated through a combination of partial agonism at dopamine D₂ and serotonin 5HT1_a receptors and antagonism of serotonin 5HT2_a receptors. Aripiprazole exhibited antagonist properties in animal models of dopaminergic hyperactivity and agonist properties in animal models of dopaminergic hypoactivity. Aripiprazole exhibited high binding affinity in vitro for dopamine D₂ and D₃, serotonin 5HT1_a and 5HT2_a receptors and moderate affinity for dopamine D₄, serotonin 5HT2_c and 5HT₇, alpha-1 adrenergic and histamine H₁ receptors. Aripiprazole also exhibited moderate binding affinity for the serotonin reuptake site and no appreciable affinity for muscarinic receptors. Interaction with receptors other than dopamine and serotonin subtypes may explain some of the other clinical effects of aripiprazole. 

Tablet 5mg 

• Abilify (H. Lundbeck) originator
• Abipip 5 (Cipla Medpro)
• Alebon 5mg (Aurogen)
• Apripent 5 (Abex Pharmaceutica)
• Aprizon 5 (Unicorn Pharmaceuticals)
• Aripiprazole 5 Teva (Teva Pharmaceuticals)
• Aripiprazole 5 Unichem (Unichem SA)
• Arizofy (Sandoz)
• Priptrin 5 (Unichem SA)
• Prizal (Camox Pharm)
• Thryve 5 (Innovata Pharmaceuticals)

Tablet 10mg 

• Abilify (H. Lundbeck) originator
• Abipip 10 (Cipla Medpro)
• Apripent 10 (Abex Pharmaceutica)
• Aprizon 10 (Unicorn Pharmaceuticals)
• Alebon 10mg (Aurogen)
• Aripiprazole 10mg Mylan (Mylan)
• Aripiprazole 10 Teva (Teva Pharmaceuticals)
• Aripiprazole 10 Unichem (Unichem SA)
• Arizofy (Sandoz)
• Priptrin 10 (Unichem SA)
• Prizal (Camox Pharm)
• Thryve 10 (Innovata Pharmaceuticals)

Tablet 15mg 

• Abilify (H. Lundbeck) originator
• Abipip 15 (Cipla Medpro)
• Alebon 15mg (Aurogen)
• Apripent 15 (Abex Pharmaceutica)
• Aprizon 15 (Unicorn Pharmaceuticals)
• Aripiprazole 15mg Mylan (Mylan)
• Aripiprazole 15 Teva (Teva Pharmaceuticals)
• Aripiprazole 15 Unichem (Unichem SA)
• Arizofy (Sandoz)
• Priptrin 15 (Unichem SA)
• Prizal (Camox Pharm)

Injection (per vial) 300mg

• Abilify Maintena (H. Lundbeck) originator

Injection (per vial) 400mg

• Abilify Maintena (H. Lundbeck) originator