Was the aripiprazole level truly high in this case?
Despite the considerations discussed above, this patient could conceivably have had usually rapid clearance of aripiprazole and thus may have needed this higher dose to achieve the levels usually achieved in the registration trials which used doses ranging from 10 to 30 mg/day and which formed the basis for the approval of this drug. For this reason, an aripiprazole level was also ordered. Unfortunately, no commercial laboratory could be found that does aripiprazole levels, based on calls to the local hospital laboratory, to several national reference laboratories, to Bristol-Myers Squibb, which co-markets the drug with its manufacturer, Otsuka, and to several research laboratories around the country. Thus, the level of aripiprazole in this case could not be assessed. Certainly, the technology exists to quantify the plasma levels of aripiprazole. In fact, these levels were measured during the development of this drug, which is a standard aspect of the drug development process.10 Yet, t
