Lemilvo (Aripiprazole)

Aripiprazole is used in the management of several psychiatric disorders by modulating dopaminergic and serotonergic pathways.

• Schizophrenia: reduces psychotic symptoms such as delusions, hallucinations and thought disorder.
• Bipolar I disorder (manic or mixed episodes): stabilizes mood and decreases frequency of manic episodes.
• Major depressive disorder (adjunctive): enhances antidepressant response when added to standard therapy.

• Aripiprazole acts as a partial agonist at dopamine D2 receptors and serotonin 5‑HT1A receptors, while antagonizing serotonin 5‑HT2A receptors. This mixed activity provides dopamine system stabilization and modulates serotonergic neurotransmission, contributing to antipsychotic and mood‑stabilizing effects without full blockade of dopamine pathways. The drug’s intrinsic activity allows it to act as a functional stabilizer, increasing dopamine transmission when it is low and decreasing it when it is excessive, thereby reducing both psychotic and mood symptoms.

Aripiprazole may be associated with a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Akathisia: inner restlessness and urge to move.
• Insomnia: difficulty falling or staying asleep.
• Nausea: mild to moderate stomach upset.
• Headache: tension‑type or migraine‑like pain.
• Anxiety: increased nervousness or tension.
• Weight gain: modest increase in body weight.
• Dizziness: feeling light‑headed.
• Elevated prolactin: occasional increase in hormone levels.

Serious or Rare Side Effects

• Neuroleptic malignant syndrome: life‑threatening reaction with fever and muscle rigidity.
• Tardive dyskinesia: persistent involuntary movements.
• Suicidal thoughts: emergence or worsening of suicidal ideation.
• Severe hypotension: marked drop in blood pressure causing dizziness.
• Seizures: rare occurrence of convulsions.

When prescribing aripiprazole, clinicians should consider several precautionary measures to ensure safe use.

• Monitor for worsening depression or emergence of suicidal thoughts: assess mood regularly.
• Evaluate cardiovascular status in patients with a history of arrhythmia or orthostatic hypotension: check blood pressure and ECG as needed.
• Use caution in patients with a history of seizures: monitor for seizure activity.
• Adjust therapy in hepatic impairment: consider reduced dosage or increased monitoring.
• Avoid abrupt discontinuation: taper gradually to prevent withdrawal or rebound symptoms.
• Store at ambient temperature: keep below 25 °C, protect from moisture and keep in original container.

Aripiprazole can interact with other medicines, affecting its plasma levels or therapeutic response.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase aripiprazole concentrations.
• Strong CYP3A4 inducers (e.g., carbamazepine, phenytoin): may reduce aripiprazole effectiveness.
• Monoamine oxidase inhibitors (MAOIs): risk of hypertensive crisis or serotonin syndrome.

Moderate Interactions (Monitor Closely)

• Other antipsychotics or dopamine‑modulating agents: may enhance side‑effect profile.
• CNS depressants (e.g., benzodiazepines, alcohol): may increase sedation.
• Antihypertensive drugs: aripiprazole may attenuate blood pressure‑lowering effects.