Aripiprazole is a medication that millions of people rely on to improve their quality of life and restore balance. Understanding how this medication works, what to expect, and what you should know before you take it is important to ensure that you get the most out of this potentially life-improving medication.
Aripiprazole is a second-generation antipsychotic or atypical antipsychotic that is used to treat medical conditions such as schizophrenia and bipolar disorder. It’s also an add-on therapy for conditions such as depression and Tourette syndrome. It’s also used off-label for other conditions.
This article provides a comprehensive guide to aripiprazole, exploring its uses, benefits, potential risks, and what to discuss with your doctor.
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What is Aripiprazole?
Second-generation antipsychotics are a class of medications approved for acute psychoses but often used for other medical conditions. There are several medications in this class, including aripiprazole.
Overview of Aripiprazole
Aripiprazole is in a class of second-generation antipsychotics designed to have a more favorable side effect profile than many of the traditional or first-generation antipsychotics. Aripiprazole is marketed under the brand name of Abilify® as well as being available as a generic. The medication has several forms which may be marketed under slightly different brand names.
- Tablets: Abilfy®
- Extended-release injections: Abilify Asimtufii®, Abilify Maintena®, Aristada®, and Aristada Initio®. A previously available immediate-release injection has been discontinued in the United States
- Oral dissolving tablet: Abilify MyCite®
- Liquid solution
The multiple forms of aripiprazole available make the medication an option for a wider variety of patients and allow more flexibility in administration.
Mechanism of Action
Aripiprazole is known as a quinolinone antipsychotic. It works by partially activating the D2 and 5HR-1a receptors in the brain and partially blocks the 5HT-2a receptor. This means that the medication will act as a partial blocker of dopamine in areas where dopamine is high, thus stabilizing levels. It will also stabilize the levels of serotonin in the brain.
Because aripiprazole only acts in levels of high dopamine and not in areas where the dopamine levels are normal, it has a lower risk of some of the side effects seen with first-generation antipsychotic medications.
Medical Uses of Aripiprazole
Aripiprazole is approved for several mental health conditions and is used off-label for others.
Approved Uses
Aripiprazole was approved by the Food and Drug Administration (FDA) in 2002 to treat the symptoms of schizophrenia. It has also been approved to treat bipolar disorder in patients with mania or mixed episodes. Aripiprazole was approved as an add-on treatment for major depressive disorder in 2006. In 2007, the medication received FDA approval for autism spectrum disorders.
In addition to the approved uses of the medication, aripiprazole is under study for use in, and sometimes used off-label for, anxiety disorders. Additionally, the medication is sometimes used off-label for the treatment of psychosis related to Alzheimer’s dementia and eating disorders.
Dosage Guidelines
Aripiprazole comes in a wide variety of doses, which can be adjusted up or down depending the characteristics unique to the individual patient.
The standard tablet form of aripiprazole comes in tablets of 2mg, 5mg, 10mg, 15mg, 20mg, and 30mg. The liquid form of the medication is available at 1mg/mL.
The long-acting injectable form of aripiprazole comes in 300-400mg doses and is usually administered once a month. There is also a long-acting prodrug form of aripiprazole, which is administered every 4-6 weeks. This form is overlapped with the oral medication when it is first started.
For bipolar disorder, aripiprazole is usually started at 15mg daily and may be increased to as much as 30mg daily if the medication is used alone. 15mg daily is the recommended dose if aripiprazole is used in combination with other medications for bipolar disorder.
For schizophrenia, aripiprazole is usually started at 10-15mg daily and may be increased to up to 30mg daily if needed. The starting dose as an add-on therapy for depression is 2-5mg. The dose may be titrated to a maximum of 15mg daily.
Aripiprazole does not require dose adjustment for people with liver or kidney disease. Still, the dose may need to be higher in people who are on certain medications that increase the amount of CYP3A4 enzyme in the liver. Aripiprazole shouldn’t be increased more than every 2 weeks.
Benefits and Effectiveness
Aripiprazole has several potential benefits for a variety of mental health conditions.
How It Helps Patients
By stabilizing dopamine and serotonin levels, aripiprazole can help patients by decreasing some of the symptoms associated with psychotic disorders, such as:
- Hallucinations
- Delusions
- Disorganized thinking
- Lack of motivation
- Disorganized speech
- Social avoidance
Aripiprazole can also help to stabilize moods and decrease mood swings. Aripiprazole may decrease irritability in patients with Autism Spectrum Disorder. Aripiprazole can decrease the tics present in Tourette’s disorder.
Unique Advantages
Aripiprazole and other second-generation antipsychotics have a more favorable side effect profile than first-generation antipsychotics. First-generation antipsychotics carry an increased risk of abnormal movements known as extra-pyramidal side effects, such as tardive dyskinesia, compared to aripiprazole.
The availability of extended-release injectable forms of aripiprazole can improve compliance with medications. It is not uncommon for patients with schizophrenia to stop taking their medications. The availability of extended-release medications makes it easer for healthcare providers, and sometimes the legal system, to ensure that patients are taking their medications as directed.
Risks and Side Effects
Like any medication, aripiprazole comes with potential side effects. Usually, these side effects are not serious, but in rare cases, they can be life-threatening.
Common Side Effects
Some of the common side effects associated with aripiprazole include:
- Blurred vision
- Drooling or increased salivation
- Stiff muscles
- Nausea, vomiting, or constipation
- Changes in appetite
- Headache
- Dizziness
- Weight gain
- Fatigue or drowsiness
- Insomnia
- Nasal congestion, sneezing, or sore throat
- Feelings of restlessness
These side effects don’t generally cause long-term damage or concerns. However, if you experience side effects of aripiprazole, it’s important to discuss them with your healthcare provider.
Rare But Serious Risks
On rare occasions, aripiprazole may cause more serious side effects. Some of the potential serious side effects of aripiprazole include:
- Uncontrollable movements of the face, lips, tongue, eyes, or extremities (tardive dyskinesia)
- Thoughts of suicide or self-harm
- Severe agitation
- Seizures or seizure-like activity
- Neuroleptic malignant syndrome: rigid muscles, high fever, sweating, confusion, abnormal heartbeats, tremor
- Decreased blood cell counts
- Increased blood sugars
If any of the above side effects occur, seek medical attention immediately. It is also important to note that aripiprazole and other atypical antipsychotics do carry a box warning for increased risk of suicidal ideation in children and adolescents as well as for the increased risk of all-cause mortality (death from any cause) in elderly people with dementia.
Managing Side Effects
Many of the side effects of aripiprazole are manageable. For side effects such as insomnia, you may be able to change the time of day you take the medication, such as taking it in the morning instead of at night. You can also use good sleep hygiene practices, such as avoiding a large meal before bed and avoiding caffeine in the afternoon.
Nausea might be managed by eating a small snack or meal with the food and avoiding rich or spicy foods. Increasing water intake may also help. Avoiding dehydration by increasing water intake may also help with headaches and constipation associated with aripiprazole.
Other side effects, such as mild restlessness, may improve with time.
Side effects such as abnormal movements or vision changes should prompt you to talk to your healthcare provider or seek immediate medical attention.
Considerations Before Starting Aripiprazole
There are many things that you may want to consider or talk to your healthcare provider about prior to starting a medication like aripiprazole.
Drug Interactions
Aripiprazole may interact with several other medications. As previously mentioned, certain medications that increase enzyme activity in the liver may cause the dose of aripiprazole to need to be increased. Other medications that may interact with aripiprazole include:
- Some antibiotics such as clarithromycin
- Antidepressants such as fluoxetine, paroxetine and nefazodone
- Certain antifungal medications like fluconazole, ketoconazole, and itraconazole
- Quinidine, a medication for heart arrhythmias
- HIV medications
This list is not meant to be exhaustive. It is important to discuss all of your medications with your healthcare provider and pharmacist prior to starting aripiprazole.
Special Populations
Aripiprazole is approved for use in children and adolescents with schizophrenia starting at age 13 and can be used in conditions such as autism as young as age six. Weight gain, drowsiness, and extrapyramidal effects, as well as the potential metabolic effects of aripiprazole, may be more important in this population, and patients on this medication should be carefully monitored.
There is limited data available about the safety of aripiprazole when used during pregnancy or breastfeeding. There is some evidence that the medication may pass into the breastmilk of mothers who are taking aripiprazole while breastfeeding. It may also decrease breastmilk production.
There is limited data suggesting that the use of aripiprazole may be associated with a slightly increased risk of preterm birth or small for gestational age babies, however the underlying conditions treated by aripiprazole also increase this risk, so there is not enough data to make a determination about whether aripiprazole was the cause of this increased risk. Generally, aripiprazole is not routinely recommended for use in pregnancy but can be used if the benefits outweigh the risks. If you are considering pregnancy, talk to your healthcare provider before stopping aripiprazole or any medication.
Aripiprazole should be used with caution in the elderly. The medication stays in the system for a long period of time and may be more likely to accumulate and interact with other medications. This risk increases in the elderly. Additionally, as previously mentioned, use of aripiprazole and other atypical antipsychotic medications carries an increased risk of all-cause mortality in elderly patients with dementia.
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Key Takeaways
- Aripiprazole is an atypical antipsychotic medication used for schizophrenia, bipolar disorder, major depressive disorder, autism, and Tourette’s syndrome
- Aripiprazole and other atypical antipsychotic medications have a more favorable side effect profile than the first-generation antipsychotics
- Many of the common side effects associated with aripiprazole will improve with time or can be managed
- Serious side effects of aripiprazole should be reported to a healthcare provider urgently
- Aripiprazole use is generally not recommended in pregnancy but may be used in some cases if the risks outweigh the benefits
Aripiprazole can be a life-changing medication for many people but isn’t right for everyone. Talk to your healthcare provider about whether aripiprazole may be a good choice for you.
For more information or support for mental health conditions, consider visiting the National Alliance on Mental Illness (NAMI), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC), or your local health department.
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