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Considerations for Augmenting Aripiprazole Long-Acting Injectables with Other Antipsychotics: A Mini-Review.
Jonathan Shaw1, Ethan Kim2, Emily Ton1
1School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA.
Aripiprazole long-acting injectable is useful for medication compliance in psychosis. However, combining it with other antipsychotics shows limited evidence and contradictory findings, necessitating further research.
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Area of Science:
- Psychopharmacology
- Neuroscience
- Clinical Psychiatry
Background:
- Aripiprazole, a third-generation antipsychotic, offers partial Dopamine D2 receptor agonism and fewer metabolic/extrapyramidal side effects.
- Its long-acting injectable formulation enhances medication compliance, crucial for preventing psychotic episode recurrence.
- Aripiprazole long-acting injectable is often used in acute settings to manage refractory symptoms, sometimes combined with other antipsychotics.
Purpose of the Study:
- To review existing literature on aripiprazole's psychopharmacology, efficacy, and adverse effects when combined with other antipsychotics.
- To compare aripiprazole's dopamine D2 receptor affinity with other antipsychotics.
- To explore the potential for augmenting aripiprazole with other agents based on receptor binding and pathway theories.
Main Methods:
- Narrative review of existing peer-reviewed literature.
- Analysis of Ki values for dopamine D2 receptor binding affinity.
- Exploration of theoretical augmentation strategies based on known receptor interactions.
Main Results:
- First-generation antipsychotics like fluphenazine and perphenazine exhibit stronger dopamine D2 receptor binding than aripiprazole.
- Limited literature exists on the efficacy and safety of combining aripiprazole with first-generation antipsychotics.
- Potential augmentation with clozapine or xanomeline-trospium is suggested by aripiprazole's muscarinic effects, but supporting literature is scarce.
Conclusions:
- There is a significant knowledge gap regarding antipsychotic polypharmacy involving aripiprazole long-acting injectable.
- Existing literature on combining aripiprazole with other antipsychotics is contradictory, hindering definitive clinical practice guidelines.
- Dopamine and muscarinic pathway theories provide a basis for future research into novel augmentation strategies for psychosis treatment.

