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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Are there any alternative medication in place of Arip with less side effects?

Answered by
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Dr. Soujanya

Psychiatrist

Practicing since :2008

Answered : 607 Questions

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Posted on Tue, 21 Aug 2018 in General Health
Question: my brother has been diagnosed with bipolar and taking medicines as below:
Lamitor 50mg, arip 5mg in morning
Lamitor 100mg, rospitril 3mg at night.
taking weekly counseling sessions too

and in regular blood check up his liver enzymes, birubin are shown as elevated (all are very mildly elevated except sgpt which 2.5 times more than usual higher limit)
he also gets irregular heart beat while excercising.

now we are concerned abt the side effects of Arip (as of now he has taken 12 dosage) like TD and on heart.
can i ask his doctor to stop arip or replace it with another medicine with less side effects. If yes which other options would be better option.
And considering his liver function can his other medicine also be reduced.
doctor
Answered by Dr. Soujanya 2 hours later
Brief Answer:
considering the side effect profile of above drugs, it is not problematic

Detailed Answer:

Hi XXXX,

Hello and Welcome to ‘Ask A Doctor’ service.

I am very sorry that due to some internet issues, I could not convey my information properly.

I have gone through your query in detail and understand that you are worried about side effect profile of Aripiprazole.

As such, there are no major side effects except some akathisia, that is subjective feeling of inner restlessness, nausea, headache and dizziness.

Tardive dyskinesia may occur, but definitely it is rarest of rare effect.

So, considering its side effect profile, it is very safest drug, and the dose he is receiving is very minimal.

I can say that there is nothing to worry about heart related effects, liver problems with the above mentioned drugs, as the doses are very minimal.

So, the raised liver enzymes, bilirubin, and heart rate could be some other reason.

I would like to know about his drinking pattern of alcohol, if is present.

Because these symptoms and deranged liver profile can be seen in dependency patients.

Please provide these details to help you.

Hope you understand the information.

Thank you.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Soujanya 32 minutes later
no he has no alcohol or smoking habit.
but to inform you further, he was diagnosed with Bipolar Disorder 2 years back and then started his medication of lamitor and rospitril.
his psychiatrist used to taper of ropitril in 4 months and lamitor continued. he stopped medicines last year Feb thinking he is completely ok , later last year in November we convinced him to start medication again so we consulted second psychiatrist who continued lamitor n ropitril and added arip to it.
as you said medicine dosage are minimal and are safe considering their effects

my concern is can liver enzyme elevation further be deteriorated with continuing these medicines ? or it can be recovered with other medicines and how serious it is ?
doctor
Answered by Dr. Soujanya 10 hours later
Brief Answer:
Lithium and amisulpiride are better in liver problems

Detailed Answer:
Hi,

Welcome back,

I have gone through your query, verified your brothers reports in detail and can understand your concern towards his liver function problems.

Among these drugs, Lamotrigine and Risperidone are hepatically metabolized, when compared to Aripiprazole which is metabolized by liver only to some extent.

So, there is a possibility of further deterioration of liver function tests with continuation of these medications, and it may also lead to liver failure.

The current liver problem can be recovered by Livogen tablets and switching off to the following ones.

Lithium, that is mood stabilizer, instead of Lamotrigine, Amisulpride instead of Aripiprazole and the other antipsychotic which is safe in liver problems is Haloperidol to some extent, as these are metabolized by mostly kidney. So liver does not get affected and get recovered soon.

So, discuss about these drugs with your doctor and can follow accordingly.

Hope this information would help you.

Thank you.
Above answer was peer-reviewed by : Dr. Prasad
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