Aripiprazole
A second-generation antipsychotic and D2 partial agonist used for schizophrenia, bipolar mania, add-on depression treatment and tics.
Drug card
- How it works
- Blocking dopamine D2 and serotonin 5-HT2A receptors
- Used for
- Schizophrenia
- Acute mania and mixed episodes in bipolar I disorder
- Depression, as add-on treatment
- Irritability in autism
- Known for
- Akathisia (restlessness)
- Urges to gamble, shop, binge-eat or have sex
- Its name
- -piprazole means an antipsychotic (aripiprazole type)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does aripiprazole work?
Aripiprazole is a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at 5-HT2A receptors. Rather than blocking D2 outright like most antipsychotics, it partly stimulates it, which steadies dopamine signaling. CYP2D6 and CYP3A4 clear it.
Like other second-generation antipsychotics: Most second-generation antipsychotics block dopamine D2 receptors together with serotonin 5-HT2A receptors, though exactly how they work is unclear; aripiprazole instead is a partial agonist at D2 receptors. As a group they cause fewer extrapyramidal effects than first-generation drugs, but many also block H1, α1 or muscarinic receptors, and weight gain with raised glucose and lipids is common.
Uses
What is aripiprazole used for?
- Schizophrenia
- Acute mania and mixed episodes in bipolar I disorder
- Depression, as add-on treatment
- Irritability in autism
- Tourette's disorder
Side effects
Side effects of aripiprazole
- Akathisia (restlessness)Known for
- Urges to gamble, shop, binge-eat or have sexKnown forSerious
- Trouble sleeping and anxiety
- Nausea and vomiting
- Constipation
- Headache
- Raised blood sugar and lipids (metabolic changes)Serious
- Weight gain
- Dizziness on standing (orthostatic hypotension)
- Tardive dyskinesiaSerious
- Suicidal thoughts in young people treated for depressionSerious
- Stroke in older people with dementiaSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Ask about new urges to gamble, spend, binge-eat or have sex; they tend to ease with a lower dose or stopping.
- When used as add-on treatment for depression, monitor young people closely for suicidal thoughts.
- Adjust the dose with strong CYP2D6 or CYP3A4 inhibitors, or strong CYP3A4 inducers, and in CYP2D6 poor metabolizers.
Good to know: Unlike most antipsychotics, it partly stimulates D2 receptors instead of simply blocking them; akathisia and restlessness are among its commonest effects.
Remember it
A way to remember it
Atypicals: fewer shakes, more cakes.
As a group they cause fewer extrapyramidal movement effects than first-generation antipsychotics, but more weight gain and raised glucose and lipids, so weight and blood tests are checked.
Written for biofideX
Its name
-piprazole means antipsychotic (aripiprazole type)
Aripiprazole and brexpiprazole share it; aripiprazole partly stimulates dopamine D2 receptors. WHO now discourages the stem because it clashes with -prazole, the proton pump inhibitors.
- Every drug name stem
Its class
Second-generation antipsychotics
Other second-generation antipsychotics with a card:
Easily mixed up with first-generation antipsychotics and lithium.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Psychosis, mood and ADHD
Aripiprazole is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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