Abilify: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 20, 2019.
1. How it works
- Abilify is a brand (trade) name for aripiprazole.
- Experts aren't sure exactly how aripiprazole works to relieve the symptoms of schizophrenia but suggest it may partially activate dopamine 2 and serotonin 1A receptors and block serotonin 2A receptors. It does appear to have some activity at other receptors, which may account for its side effects (for example its tendency to cause low blood pressure on standing may be due to its blocking effect on adrenergic alpha1 receptors).
- Aripiprazole belongs to the class of medicines known as atypical antipsychotics (atypical means it is less likely than older antipsychotics to cause side effects, and more likely to be effective in the treatment of symptoms such as lack of motivation and social withdrawal).
- Used to relieve symptoms of psychosis and agitation associated with schizophrenia and manic or mixed episodes of bipolar I disorder.
- May also be used in addition to other medications in the treatment of depression.
- May be used to reduce irritability associated with Autistic disorder.
- Reduces tic severity in Tourette's syndrome.
- Available as a tablet, an orally disintegrating tablet, an oral solution, and an extended-release intramuscular injection.
- Generic aripiprazole is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Akathisia (an inner restlessness), sedation, headache, insomnia, agitation, anxiety, nausea, tremor. Other reasonably common side effects include constipation, vomiting, dry mouth, stomach upsets and extrapyramidal symptoms (such as restlessness, tremor, uncontrolled muscle contractions). May also cause difficulty when swallowing.
- Should not be used for the treatment of dementia-related psychosis in elderly people as associated with a higher risk of death.
- If being used as an adjunct therapy in the treatment of depression, monitor for worsening depression, agitation or mood changes.
- May cause a drop in blood pressure on standing, particularly during the initial dose titration period; dosage may need reducing. May not be suitable for people with cardiovascular disease (history of a heart attack, angina, heart failure, or arrhythmia), stroke, seizure disorders, and people at risk of dehydration.
- Blood levels may need monitoring as Abilify can cause numbers of white blood cells to decrease.
- May increase blood sugar levels. People with a history of diabetes or at risk of diabetes should be monitored closely. Less likely than some other antipsychotics to cause undesirable changes in blood cholesterol and lipid levels or to cause weight gain.
- Potentially irreversible tardive dyskinesia can develop, even with low dosages used short-term. Symptoms include facial grimacing, repetitive chewing, and tongue thrusting.
- Rarely, may cause Neuroleptic Malignant Syndrome; symptoms include high body temperature, muscle rigidity, and mental disturbances; discontinue immediately and seek urgent medical advice.
- May interact with a number of drugs, including benzodiazepines, carbamazepine, fluoxetine, and itraconazole. See prescribing information for a full list of interactions.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- May be administered with or without food.
- Take only as directed by your doctor. Do not increase the dosage without your doctor's advice.
- Abilify is available as oral tablets, orally-disintegrating tablets, and an oral solution. Disintegrating tablets should not be removed from their blister until ready to administer. Dry hands should be used to peel back the foil on the blister rather than attempting to pop the tablet through the foil. The tablet should then be placed on the tongue. May be taken with or without liquid, but do not attempt to split the tablet.
- May cause sedation or impair judgment skills and affect your ability to drive or operate machinery. Avoid alcohol.
- Avoid overheating and dehydration.
- Seek urgent medical advice if you develop uncontrolled body movements, confusion, high fever, lightheadedness, fainting, seizures, have problems controlling your body temperature, or difficulty swallowing.
- Talk to your doctor or pharmacist before buying other medications over the counter to check that they are compatible with Abilify.
6. Response and Effectiveness
- Peak blood levels are reached within three to five hours of taking oral Abilify. Effects are long lasting, so Abilify is usually taken once daily.
- May take up to two weeks to achieve stable blood concentrations.
- Target dosages of 10-15mg per day of Abilify are recommended for schizophrenia; dosages above 15 mg/day have not been found to be more effective than 15 mg/day.
- Dosage reductions may be needed for people known to be poor metabolizers of drugs like Abilify, or in people taking other medications known to interfere with the hepatic enzymes CYP2D6 and CYP3A4. Conversely, a dosage increase of Abilify may be needed when given with medications that induce CYP3A4.
Medicines that interact with Abilify may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Abilify. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with Abilify include:
- anti-anxiety medications, including other benzodiazepines, such as diazepam and oxazepam
- anticonvulsants, such as phenytoin
- antidepressants, such as amitriptyline, imipramine, nortriptyline
- antifungals, such as itraconazole or ketoconazole
- antihistamines that cause sedation, such as diphenhydramine
- HIV medications such as indinavir and ritonavir
- grapefruit juice and products
- migraine treatments, such as rizatriptan and sumatriptan
- monoamine oxidase inhibitors, such as selegiline, isocarboxazid, or phenelzine
- opioid analgesics such as oxycodone and morphine
- muscle relaxants such as cyclobenzaprine
- serotonin modulators, such as nefazodone and trazodone
- sleeping pills, such as zolpidem
- some chemotherapy treatments
- some heart medications, such as doxazosin and prazosin
- other medications used to treat mental illness, such as clozapine and thioridazine
- any medication that inhibits or induces CYP2D6 or CYP3A4.
Alcohol may worsen the side effects of Abilify such as drowsiness, dizziness, and liver toxicity.
Note that this list is not all-inclusive and includes only common medications that may interact with Abilify. You should refer to the prescribing information for Abilify for a complete list of interactions.
Abilify (aripiprazole) [Package Insert] Revised: 08/2019. Bristol-Myers Squibb https://www.drugs.com/pro/abilify.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Abilify only for the indication prescribed.
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