Aripiprazole (Abilify): Uses, Dose, and Side Effects

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Aripiprazole (Abilify) is an atypical antipsychotic. Its uses include the treatment of schizophrenia and bipolar I disorder. It works by restoring the balance of certain natural chemicals in the brain (neurotransmitters). It can reduce hallucinations, improve concentration, help you think more clearly, feel positive and less nervous, and play a more active role in everyday life. Aripiprazole can decrease the severity and frequency of mood swings. The most common side effects of aripiprazole (Abilify) include nausea, vomiting, dizziness, restlessness, blurred vision, constipation, headache, anxiety, sleeplessness, and inner feeling of restlessness or need to constantly move (akathisia).

A box of aripiprazole
Aripiprazole (Abilify) (Picture credit: https://www.mims.co.uk/)

Uses of Aripiprazole

The uses of Abilify include the treatment of:

  • Schizophrenia in adults and in adolescents 13–17 years of age
  • Manic or mixed episodes in Bipolar I Disorder in adults, and in children and teens 10–17 years of age
  • Major depression, along with an antidepressant in those who are responding inadequately to antidepressant therapy
  • Irritability in Autism in patients 6–17 years of age
  • Tourette’s Disorder in patients 6–18 years of age

Dose of Aripiprazole/Abilify

The doses of aripiprazole given below are for adults unless otherwise specified. Children will require lesser doses. It can be given with or without meals.

Dose for Schizophrenia

The recommended initial dose for aripiprazole is 10 or 15 mg/day in a single dose. The dose should be adjusted only after 2 weeks, the time it takes for the medication to achieve steady-state levels. The maintenance dose is 15 mg/day. Reassess periodically the need for maintenance therapy.

Dose for Bipolar I Disorder

The starting dose in acute treatment of manic and mixed episodes is 15 mg given once daily if given alone. It is 10–15 mg given once daily as adjunctive therapy with lithium or valproate. The target dose of Abilify is 15 mg/day both in monotherapy and adjunctive therapy with lithium or valproate. The dose can be increased to 30 mg/day depending on clinical response.

Adjunctive Treatment of Major Depression

The starting dose for aripiprazole as adjunctive treatment of major depression for patients already on an antidepressant is 2–5 mg/day. The range is 2 to 15 mg/day. The dose should be adjusted gradually to 5 mg/day at 1-week intervals. Reassess periodically to determine the need for maintenance treatment based on response.

Irritability Associated with Autistic Disorder

The recommended dose for pediatric patients (6 to 17 years) with irritability associated with autistic disorder is 5–15 mg/day. The starting dose is 2 mg/day. The dose should be increased to 5 mg/day gradually at 1-week intervals, even going up to 10 or 15 mg/day if needed. Reassess periodically to determine the need for ongoing maintenance treatment based on response.

Tourette’s Disorder

The recommended dose for Tourette’s Disorder in pediatric patients (6 to 18 years) is 5 to 20 mg/day. For those less than 50 kg, start at 2 mg/day with a target dose of 5 mg/day after 2 days. The dose can go up to 10 mg/day if tics are not controlled adequately. Dosage adjustments should be made gradually at intervals of 1 week.

For those who weigh 50 kg or more, start at 2 mg/day for 2 days, increasing to 5 mg/day for 5 days, with a target dose of 10 mg/day on day 8. The dose can go up to 20 mg/day if tics are not adequately controlled. Dosage should be adjusted gradually in steps of 5 mg/day at 1-week intervals. Reassess periodically the need for maintenance treatment.

Agitation Associated with Schizophrenia or Bipolar Mania (Intramuscular Injection)

The recommended dose is 9.75 mg, with a dosage range of 5.25–15 mg. If a second dose is needed to control the agitation, you can go up to a total of 30 mg/day. If continued Abilify therapy is needed, substitute Abilify injection with oral Abilify 10–30 mg/day as soon as possible.

What if I miss a dose?

Take it as soon as you remember. Skip it if it is almost time for the next scheduled dose. Do not double the dose to make up for the missed dose.

What if I overdose?

Overdose symptoms may include unusual drowsiness or sleepiness, nausea, vomiting, diarrhea, aggression, confusion, tremors, lack of strength, increased or decreased heart rate, seizure (convulsions), trouble breathing, or fainting. Seek emergency medical help if those symptoms occur.

Side Effects of Aripiprazole

Common Abilify side effects include:

  • Nausea, vomiting, changes in appetite, constipation
  • Drooling
  • Weight gain
  • Blurred vision
  • Headache, dizziness, drowsiness, feeling tired
  • Anxiety, restlessness
  • Insomnia
  • Stuffy nose, sneezing, sore throat
  • Difficulty with speaking
  • Impaired balance
  • Trembling, jerking, or stiffness of muscles
  • Shuffling walk

Less common side effects of aripiprazole are:

  • Lightheadedness or fainting may happen when rising too quickly from a sitting or lying position, due to a sudden fall in blood pressure (orthostatic hypotension).
  • Low white blood cell count
  • Seizures (convulsions)
  • Impaired regulation of body temperature. Avoid getting over-heated or dehydrated. In hot weather, stay inside in a cool place if possible. Drink plenty of water.
  • Difficulty swallowing
  • Allergic reaction: Symptoms include swollen, pale red bumps or wheals on the skin that appear suddenly, and cause itching and burning sensation; difficulty in breathing; swelling of face, lips, tongue, or throat. Get emergency medical help.
  • Extrapyramidal symptoms at high doses:
    • Acute dystonias: involuntary movements (restlessness, muscle spasms, protruding tongue, fixed upward gaze, neck muscle spasm). They occur commonly in the first few weeks, often declining with time, and are reversible on stopping drug treatment.
    • Tardive dyskinesia: It develops after months or years of treatment. It consists of involuntary movements, often of the face and tongue, but also of trunk and limbs.
  • Neuroleptic malignant syndrome: Symptoms of high fever, muscle stiffness or pain or weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, change in the amount of urine. These may be symptoms of a rare and serious condition that can lead to death. Contact emergency medical services immediately.

Precautions with Aripiprazole

Abilify is not approved for use in psychotic conditions related to dementia. There is an increased risk of death in older adults with dementia-related conditions when treated with Abilify.

In younger people on aripiprazole, thoughts about suicide can occur in psychotic conditions. Pay attention to changes in mood or symptoms. Contact your doctor if there is a worsening of symptoms.

Stop using Abilify and seek emergency medical help if these symptoms occur: fever with muscle stiffness and increased heart rate; uncontrollable muscle movements; sudden numbness or weakness, severe headache, and problems with vision, speech, or balance.

Abilify may cause high blood sugar. Check blood sugar regularly if you are a diabetic.

Abilify may impair thinking and reactions. Be careful about driving or doing anything that requires alertness. Avoid getting up too fast from a sitting or lying position, because it can cause dizziness, leading to falls, fractures, or other injuries.

Dangerous side effects can occur if the medication is taken with alcohol.

Use in Pregnancy and Breastfeeding

Aripiprazole should be used in pregnancy only if its benefit outweighs the risk. Its use during the last 3 months of pregnancy can cause serious symptoms in newborn babies, such as muscle stiffness, drowsiness, feeding or breathing difficulties, or constant crying.

Aripiprazole passes into breast milk. So, avoid breastfeeding when you are taking aripiprazole.

Interactions with Aripiprazole or Abilify

More than 600 drugs are known to interact with aripiprazole (Abilify). Of these, only around 30 are major drug interactions. Aripiprazole can cause dangerous or life-threatening side effects if you take it along with a sleeping pill, opioid pain medicine, cough relievers, muscle relaxants, antihistamines, or drugs for anxiety, depression, or seizures. Other substances interacting with aripiprazole include vitamins and herbal products.

Bibliography

Abilify.com, 2018. Abilify. [Online]
Available at: https://www.abilify.com/
[Accessed 4 Sep 2019].

Brunton, L., 2018. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 13 ed. New York: McGraw Hill.

Drugs.com, 2019. Abilify. [Online]
Available at: https://www.drugs.com/abilify.html
[Accessed 4 Sep 2019].

Ritter, J. et al., 2020. Rang and Dale’s Pharmacology. 9 ed. Edinburgh: Elsevier.

Sadock, B. J., Sadock, V. A. & Ruiz, P., 2017. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer.

WebMD, n.d. Abilify. [Online]
Available at: http://www.webmd.com/drugs/2/drug-64439/abilify-oral/details
[Accessed 4 Sep 2019].

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Aripiprazole (Abilify): Uses, Dose, and Side Effects
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Aripiprazole (Abilify): Uses, Dose, and Side Effects
Description
Aripiprazole (Abilify) is an antipsychotic used to treat psychosis, mania & depression. It has less serious side effects than 1st gen antipsychotics.
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DepressionPedia.org
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