Aripiprazole

Drug Levels and Effects:




Summary of Use during Lactation:


Limited information indicates that maternal doses of aripiprazole up to 15 mg daily produce low levels in milk, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.


Drug Levels:


Maternal Levels.

A women who was 6 months postpartum was taking aripiprazole 15 mg by mouth daily. Milk levels after 11 and 12 days of therapy (times not stated) at that dose were 13 and 14 mcg/L.[1]

A woman took aripiprazole 15 mg daily by mouth during pregnancy and postpartum. At 3 days postpartum, aripiprazole was not detectable in colostrum because of an unknown substance that interfered with the assay. On day 27 postpartum, 3 additional milk samples were collected at 30 minutes before the dose (24 hours after the last dose), and 4 and 10 hours after the dose. The drug and its metabolite were undetectable (<10 mcg/L) in all samples. The authors estimated that a fully breastfed infant would receive less than 0.7% of the maternal weight-adjusted dosage.[2]

A woman was taking aripiprazole 18 mg daily. On day 6 postpartum, a breastmilk sample (time not reported) contained a concentration of aripiprazole of 38.7 mcg/L.[3]

Infant Levels.

A woman was taking aripiprazole 18 mg daily during pregnancy and postpartum. On day 6 her breastfed infant had a serum concentration of 7.6 mcg/L, although some portion of the concentration could have been residual from transplacental transmission because of the drug's on half-life.[3]


Effects in Breastfed Infants:


A woman took aripiprazole 15 mg daily by mouth during pregnancy and postpartum. She breastfed her infant (amount not stated) and at 3 months of age, the infant was growing normally.[2]


Possible Effects on Lactation:


Unlike the phenothiazines, aripiprazole has a minimal effect on serum prolactin levels and it has been used to reverse hyperprolactinemia in patients taking other antipsychotics.[4][5][6][7][8][9][10][11][12] However, 2 cases of galactorrhea apparently caused by aripiprazole have been reported.[13][14]

One woman began taking aripiprazole 10 mg daily at week 20 of pregnancy. She underwent a cesarean section delivery at term, but was unable to establish lactation. The authors suggested that more data are needed to determine if aripiprazole adversely affects lactation.[15]

The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.


Alternate Drugs to Consider:


Haloperidol,Olanzapine


References:


1. Schlotterbeck P, Leube D, Kircher T, Hiemke C, Grunder G.Aripiprazolein human milk . Int J Neuropsychopharmacol. 2007;10:433. PMID:17291382
2. Lutz UC, Hiemke C, Wiatr G et al.Aripiprazolein pregnancy and lactation a case report. J Clin Psychopharmacol. 2010;30:204-5. Letter. PMID:20520299
3. Watanabe N, Kasahara M, Sugibayashi R et al. Perinatal use of aripiprazole : a case report. J Clin Psychopharmacol. 2011;31:377-9. PMID:21532364
4. Goodnick PJ, Rodriguez L, Santana O. Antipsychotics: impact on prolactin levels. Expert Opin Pharmacother. 2002;3:1381-91. PMID:12387684
5. Kane JM, Carson WH, Saha AR et al. Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry. 2002;63:763-71. PMID:12363115
6. Byerly MJ, Marcus RN, Tran QV et al. Effects of aripiprazole on prolactin levels in subjects with schizophrenia during cross-titration with risperidone or olanzapine: analysis of a randomized, open-label study. Schizophr Res. 2009;107:218-22. PMID:19038534
7. Boggs AA, Bihday C, Boggs DL.Aripiprazole's effects on risperidone consta induced hyperprolactinemia: A case report. J Pharm Pract. 2012;25:298. Abstract.
8. Lorenz RA, Weinstein B. Resolution of haloperidol-induced hyperprolactinemia with aripiprazole . J Clin Psychopharmacol. 2007;27:524-5. PMID:17873694
9. Rocha FL, Hara C, Ramos MG. Using aripiprazole to attenuate paliperidone-induced hyperprolactinemia. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34:1153-4. PMID:20547197
10. van Kooten M, Arends J, Cohen D. Preliminary report: a naturalistic study of the effect of aripiprazole addition on risperidone-related hyperprolactinemia in patients treated with risperidone long-acting injection. J Clin Psychopharmacol. 2011;31:126-8. PMID:21192158
11. Wahl R, Ostroff R. Reversal of symptomatic hyperprolactinemia by aripiprazole . Am J Psychiatry. 2005;162:1542-3. PMID:16055781
12. Wolf J, Fiedler U. Hyperprolactinemia and amenorrhea associated with olanzapine normalized after addition of aripiprazole . J Clin Pharm Ther. 2007;32:197-8. PMID:17381670
13. Mendhekar DN, Andrade C. Galactorrhea with aripiprazole . Can J Psychiatry. 2005;50:243. Letter. PMID:15898468
14. Ruffatti A, Minervini L, Romano M, Sonino N. Galactorrhea with aripiprazole . Psychother Psychosom. 2005;74:391-2. PMID:16244518
15. Mendhekar D, Sunder KR, Andrade C.Aripiprazoleuse in a pregnant schizoaffective woman. Bipolar Disord. 2006;8:299-300. PMID:16696834



Substance Identification:




Substance Name:

Aripiprazole

CAS Registry Number:

129722-12-9

Drug Class:


  • Antipsychotic Agents


  • Administrative Information:




    LactMed Record Number:


    17


    Last Revision Date:


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