Abilify (Aripiprazole)

Abilify (aripiprazole) is a second-generation antipsychotic (SGA) for schizophrenia, bipolar disorder, and major depressive disorder. Abilify is a brand name for aripiprazole, first approved by the FDA in 2002 and produced by Bristol-Myers Squibb.

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What does Abilify treat?

Abilify is often used as an add-on therapy for adults with major depressive disorder (MDD) who don't respond well to antidepressants alone. Other disorders include:

Schizophrenia

Schizophrenia is a severe mental disorder that affects less than 1% of the population in the United States. Abilify (aripiprazole) can treat schizophrenia in adults and adolescents over 13 years old. 

Symptoms of schizophrenia include:

  • Hallucinations: Hearing voices or seeing images that appear real. Sometimes the person can smell things that are not real or feel sensations on their skin that are not there.

  • Delusions: Beliefs about things that are not true or based in reality, such as believing that others can read their thoughts or that someone is out to get them (paranoia).

  • Disorganized thinking or speech: Difficulty communicating and saying things that don’t make sense. 

  • Disorganized or abnormal motor behavior: Becoming agitated and restless, making strange movements with the arms or body, or sitting with unusual posture.

  • Negative symptoms: Difficulty functioning normally, such as inability to maintain personal hygiene, social withdrawal, and inability to feel or express emotion.

Tourette's syndrome

Tourette's syndrome is a neurological disorder. People with Tourette's have uncontrollable tics and vocalizations. Tics are uncontrollable movements.

Aripiprazole is federally approved to treat Tourette's syndrome¹ in people 6 to 18 years old. Aripiprazole may treat tics (sudden, rapid movements or sounds) and obsessive-compulsive disorder (unwanted thoughts or behaviors that are difficult to stop).

Irritability associated with autism

Abilify is used to treat people with autism aged 6-17 years old who have problems with irritability.

People with autism have a high rate of aggressiveness and irritability. According to one study, up to 20% of children with autism² display aggressive behaviors.

Abilify will significantly reduce the severity of irritability and aggression for these people.

Major depressive disorder (MDD)

MDD is one of the most common mood disorders in the United States, affecting approximately 16 million people each year³.

Major depression can cause severe impairments that interfere with or limit your ability to carry out major daily activities. Sometimes, people with severe depression can experience hallucinations and/or delusions.

Abilify can treat MDD by restoring the balance of certain chemicals in your brain. As a result, the drug can decrease hallucinations and delusions, improve concentration, and help you think more clearly.

Bipolar disorder

Bipolar disorder causes people to experience highs and lows in their mood—known as mania or depression—that differs from the typical ups and downs most people experience. Bipolar disorder affects men and women equally.

Around 2.8% of the US population has a bipolar disorder diagnosis, and about 83% of cases are considered severe.

Abilify effectively treats pediatric patients between 10 and 17 and adults with manic or mixed bipolar episodes. 

Symptoms of bipolar disorder: 

  • Depression

  • Mania

  • Decreased need for sleep

  • Being more talkative than usual or having rapid speech

  • Inflated self-esteem or grandiosity

  • Experiencing many different thoughts and ideas at the same time (i.e., “racing thoughts”)

  • Becoming easily distracted or very focused on unimportant things or activities

  • Agitation and an increased focus on one or more specific activities

  • Involvement in high-risk activities

  • Having suicidal thoughts

  • Extreme mood swings

How do you take Abilify?

Take this medication daily with or without food as instructed by your doctor. 

Your doctor will base the dosage on your current medical condition, response to treatment, age, and other medicine you might be taking at the moment.

Your doctor may start this medication at a low dose and gradually increase your dosage to reduce the risk of side effects. Follow your doctor's instructions carefully to avoid such risks.

Oral Tablets (available in 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg strengths)

Swallow the tablets whole. Do not break, crush, or chew this medication. Always follow your doctor's directions on how to take this medication properly.

Oral solution (1 mg/ml)

If you are using the liquid solution of Abilify, carefully measure the dose using the included measuring cup.

Avoid using a common household spoon because you may not get the correct measurement for your dose.

Dosage for depression

When taking Abilify for depression, the starting daily dosage is between 2 and 5 mg. Then your doctor will increase the dosage up to 5 mg each week until your depression symptoms lessen.

Dosage for pediatric patients

Abilify is FDA-approved for use in children; however, approved uses are based on your child’s age and specific disorder. If you are concerned about using Abilify for your child, talk to a pediatrician.

Dosage for schizophrenia patients

The recommended starting dose for adults with schizophrenia taking Abilify is usually 10-15 mg per day, as it is the most effective dose. If you're still experiencing symptoms of schizophrenia after two weeks of taking Abilify, your doctor may increase your dosage.

The typical maintenance dose for Abilify for people with schizophrenia is between 10-30 mg per day. However, amounts greater than 15 mg daily may not be more beneficial.

Seeing results 

It may take up to four weeks before you see the full effects of Abilify. Your doctor will need to regularly check in with you to monitor your progress and side effects. Do not stop taking Abilify without talking to your doctor first.

In 1-2 weeks

Regular medication improves your motivation and desire. Hallucinations, disorganized thinking, and paranoia may improve in the first few weeks. You must continue taking the drug as prescribed by your doctor, even if you feel better.

In 2-3 months

It might take between two to three months before you get the full benefit of Abilify. Keep in touch with your doctor to monitor your progress and side effects. Do not stop taking Abilify without talking to your doctor first.

Warning: Do not increase how much of this drug you take or how often you take it—modifying the dosage or taking it for longer than prescribed will not improve your condition faster. Such changes could worsen your condition and increase your risk of side effects.

Potential side effects of Abilify 

Some side effects may occur during treatment with Abilify. These include:

Weight gain

Taking Abilify may cause you to gain weight: Clinical trials reported weight gain in adults with schizophrenia, bipolar disorder, and major depressive disorder (MDD). However, this is not a very common side effect for adults taking the drug.

Weight gain was not reported in any other group of adults during the trials except for adults with bipolar disorder, schizophrenia, and major depressive disorder (MDD).

Insomnia 

Insomnia is a condition where you have trouble falling asleep or staying asleep. It's not unusual for people who take certain medications to experience insomnia during their treatment.

Effects of insomnia:

  • Fatigue

  • Mood swings

  • Stress

  • Decrease brain performance

You can do many things to manage this side effect: Avoid caffeine during the day, establish a regular sleep schedule, and use relaxation techniques before bedtime.

Nausea

Feeling nauseous while taking this drug is one of the most common side effects of Abilify.

If you take Abilify before going to bed, this may reduce your nausea. If the feeling of sickness doesn't get better or worsens, contact your doctor.

Sex-related side effects

Abilify can also affect your sex life, such as sexual urges. According to clinical trials, Abilify can cause priapism, a prolonged and painful erection not related to sexual stimulation. Other sexual side effects also include:

  • A decrease in libido or sexual urges in both men and women

  • A loss of menstrual periods

  • Reduced milk production for women who are breastfeeding

If you have changes in your sex drive while taking Abilify, talk with your doctor.

If you’re a man, Abilify may lessen the amount of sperm⁴ you produce. If you’re a woman, it may cause an increase in menstrual bleeding. These usually go away after you stop treatment.

Behavioral side effects

When you take Abilify, you may experience unusual urges, including binge eating, gambling, compulsive shopping, eating that you cannot control, and sexual urges. If you notice that you're experiencing unusual desires or behaviors, discuss them with your doctor immediately.

Long-term use of Abilify

Bone-related effects

Abilify (aripiprazole) may cause increased prolactin in the blood. Long-term (months to years) elevated prolactin levels can cause osteoporosis or an increased risk of bone fractures.

Muscle-related effects

A few people may develop muscle-rela­ted side effects when taking Abilify. These are:

1. Extrapyramidal symptoms (EPS): Symptoms of EPS include feeling restless, having a tremor, and feeling stiff.

2. Tardive dyskinesia (TD): TD causes uncontrollable slow or jerky movements. This often starts with movements in the mouth, such as tongue rolling or chewing.

Diabetes

There is some evidence that Abilify may increase the risk of diabetes, a condition in which blood sugar levels are too high.

Your doctor may be able to adjust your dose or prescribe a different medication to curb these side effects.

Arrhythmia

All antipsychotics (which include Abilify) are associated with a risk of sudden cardiac death. This is because they can cause an arrhythmia or an irregular heartbeat. To minimize this danger, your doctor may prescribe the lowest effective dosage. They can also request an EKG to look for any abnormal heartbeat.

Blood-related effects

Antipsychotics like Abilify may cause various side effects, including abnormal changes in blood pressure, seizures, high cholesterol, low white blood cell count, trouble controlling body temperature, and difficulty swallowing.

Increased mortality among elderly patients

Some elderly patients with dementia may have a higher risk of death when taking antipsychotic drugs, like Abilify.

Although the causes of death were varied, most of the deaths appeared to be:

  • Stroke

  • Heart failure

  • Sudden death

  • Pneumonia

Boxed warning

Abilify has a boxed warning, which indicates its most serious warning from the Food and Drug Administration (FDA). These warnings alert doctors and patients about dangerous drug effects.

Missed doses

If you miss a dose of Abilify, here are the steps you should take:

  1. Take your missed dose when possible. 

  2. Skip the missed dose if it is almost time for your next dose. 

  3. Take your next dose at the regular time. 

  4. Never take double doses to make up for a missed dose.

Keep taking this medicine even if you feel well. Don't stop taking Abilify without consulting with your doctor first. Some conditions may become worse if you suddenly stop Abilify. 

Overdoses

Take the lowest possible amount of this medication that relieves your symptoms. Never take more than your doctor prescribes. Overdosing on Abilify will not improve your condition any faster. 

Symptoms of overdose:

  • Drowsiness

  • Weakness

  • Widened pupils 

  • Nausea

  • Vomiting

  • Movements you cannot control

What to discuss with your doctor before you start taking Abilify

Discuss the following points with your doctor before starting Abilify: 

  1. What symptoms are bothering you the most?

  2. Are you feeling depressed, suicidal, or wanting to harm yourself?

  3. Tell your doctor if you've ever had muscle stiffness, shaking, tardive dyskinesia (TD), neuroleptic malignant syndrome (NMS), or weight gain from a drug.

  4. Past medications you've tried for your condition, whether they were helpful or caused any negative effects.

  5. Any family history of long QT syndrome (LQTS), heart problems, diabetes, high cholesterol levels, or seizures.

  6. Tell your doctor if you have any other health conditions, including heart problems, nervous system disorders, swallowing problems, breathing difficulties during sleep, or blood-related issues such as low white blood cell count. 

Stopping Abilify

If you're going to stop taking Abilify, talk to your doctor first about tapering off the medicine. Your doctor will gradually reduce your dosage over time to decrease your chance of experiencing withdrawal symptoms.

Alternative drugs are available that can treat your mental illness. If you're interested in looking for an alternative prescription to Abilify, then consult your doctor. They can recommend other medications that may work well for you.

Withdrawal symptoms

Abilify is not a controlled substance, although you may become dependent on it, which is not the same as an addiction. Dependence means that you may experience physical withdrawal symptoms or develop a tolerance to the drug. 

Because Abilify affects the way your brain works, suddenly discontinuing taking Abilify may lead to withdrawal symptoms. This is especially true if you've been taking it for a long time or at a higher dose.

Common withdrawal symptoms: 

  • Increased anxiety

  • Changes in appetite

  • Concentration problems

  • Confusion

  • Depression

Abilify and pregnancy

If you're planning to get pregnant, let your doctor know. They can manage your medications. Pregnant women with schizophrenia must decide whether they want to take antipsychotic medication during their pregnancy. It is important to talk about the risks and benefits of any treatment with your doctor and care providers.

The use of antipsychotics during pregnancy may cause EPS and/or withdrawal symptoms after birth. Newborns may exhibit agitation, an eating disorder, low muscle tone, respiratory distress, sleepiness, and tremors. These effects may be temporary, or they may require hospitalization.

Breastfeeding 

Caution is advised with breastfeeding since aripiprazole does pass into breast milk. If your infant is exposed to SGAs via your breast milk, a doctor should check them weekly for symptoms such as decreased appetite or sleep problems for the first month of exposure.

Interactions with other drugs

It’s important to tell your doctor about any other medications you are taking, including over-the-counter drugs and supplements.

Abilify can interact with other medications and cause serious side effects. Some of the most common interactions include:

Medications that increase the effects of aripiprazole:

  • Antidepressants, such as fluoxetine, paroxetine, and nefazodone

  • Antifungals, such as fluconazole, ketoconazole and itraconazole

  • The antiarrhythmic agent quinidine

  • HIV medications, such as the protease inhibitor indinavir

Medications may lessen the effects of aripiprazole:

  • Rifampin

  • Carbamazepine

Other effects

As Abilify can also cause decreased blood pressure (BP), blood pressure medications may interact. These drugs include prazosin and doxazosin. If you're taking any blood pressure medications, discuss them with your doctor or pharmacist before starting Abilify.

Allergy information

Some people may experience side effects when they take Abilify. But it's not clear how many people experienced side effects from Abilify during clinical studies.

Minor allergic reaction

If you experience a rash, it could be an allergy. It's not common, but you could develop a more serious allergic reaction.

Severe allergic reaction 

In some rare cases, severe allergic reactions may occur. Symptoms include swelling under the skin or throat, difficulty breathing, and throat swelling.

If these adverse reactions occur, you must discontinue taking the drug and get medical help immediately.

Clinical trial history

The following well-controlled clinical studies⁵ established the effectiveness of Abilify (aripiprazole):

Schizophrenia

Four clinical trials, one short-term maintenance trial in adults, and one short-term study in adolescents.

Manic or mixed episodes

One short-term monotherapy study, one six-week add-on therapy study in adults, and one short-term monotherapy study in children.

One maintenance monotherapy and one maintenance adjunctive therapy trial in adults with bipolar disorder

Major depressive disorder (MDD)

Two short-term clinical trials in adult patients.

Observed results

Multiple controlled clinical trials show that Abilify effectively treats schizophrenia, manic or mixed episodes, bipolar I disorder, and major depressive disorder.

With effective treatment, most people with these disorders improve to a point where they can live relatively normal lives.

Tips and advice for taking Abilify

If you are taking Abilify, there are certain things you should avoid doing, such as:

  1. Avoid getting up too quickly from a sitting position, or you may feel dizzy.

  2. Do not engage in hazardous activities until you know how this medicine will affect you. Dizziness and drowsiness can cause falls, collisions, and serious injuries.

  3. Avoid alcohol. Adding alcohol to the mix adds another substance that can disproportionately affect your brain. Having all these effects going on at once can often create more problems.

  4. While taking Abilify, you may be more sensitive to very hot conditions. Drink plenty of fluids to avoid being overheated and dehydrated.

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Disclaimer

Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.

However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.

It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.

Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.

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