Aripiprazole and hyperlipidaemia

Aripiprazole is associated with a lower risk of hyperlipidaemia than low potency conventional antipsychotics (e.g., chlorpormazine, thioridazine) and many of the atypical antipsychotics (quetiapine, olanzapine and clozapine) (1)

A case series of switching antipsychotic treatment evaluated metabolic markers at 3 months post switching to aripiprazole (2):

• in patients switched to aripiprazole
  • there was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels

Use of aripiprazole in children (3):

• a 12 week study evaluated the cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents
  • metabolic baseline-to-end-point changes were not significant with aripiprazole or in the untreated comparison group

Switching antipsychotic treatment to aripiprazole from other atypical antipsychotics (4):

• switching to aripiprazole led to improvement of non-HDL cholesterol levels and other metabolic parameters

But..

• there has been case study evidence of increases in lipids with aripiprazole treatment
  • a case study details switching of antipsychotic from olanzapine to aripiprazole (5)
    • at the time of switching lipid levels were within reference range. However hyperlipidaemia was noted after treatment with aripiprazole and resolved with reduction of aripiprazole dose
• reviews note that, though the risk of hyperlipidaemia is relatively low with aripiprazole, there is a residual risk (1,6)

Notes:

• a comprehensive review on the effects of antipsychotic therapy on serum lipids (1):
  • high-potency conventional antipsychotics (e.g., haloperidol) and the atypical antipsychotics, ziprasidone, risperidone and aripiprazole, appear to be associated with lower risk of hyperlipidemia
  • low-potency conventional antipsychotics (e.g., chlorpormazine, thioridazine) and the atypical antipsychotics, quetiapine, olanzapine and clozapine, are associated with higher risk of hyperlipidemia
  • recommended that a lipid panel be obtained at baseline in all patients with schizophrenia, annually thereafter for patients on agents associated with lower risk of hyperlipidemia and quarterly in patients on agents associated with higher risk for hyperlipidemia.
    • "..all patients with persistent dyslipidemia should be referred for lipid-lowering therapy or switched to a less lipid-offending antipsychotic agent..."

Reference:

• 1) Schizophr Res. 2004 Sep 1;70(1):1-17.
• 2) De Hert M et al. A case series: evaluation of the metabolic safety of aripiprazole. Schizophr Bull. 2007 May;33(3):823-30. Epub 2006 Aug 29.
• 3) Correll CU et al. JAMA. 2009 Oct 28;302(16):1765-73. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents.JAMA. 2009 Oct 28;302(16):1765-73.
• 4) Stroup TS et al. A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP). Am J Psychiatry. 2011 Sep;168(9):947-56. Epub 2011 Jul 18.
• 5) Uzun S et al. Changes in values of cholesterol and tryglicerides after weight loss during treatment with aripiprazole in a patient with schizophrenia - Case report.Psychiatr Danub. 2010 Jun;22(2):373-6.
• 6) Koro CE, Meyer JM.Atypical antipsychotic therapy and hyperlipidemia: a review.Essent Psychopharmacol. 2005;6(3):148-57.