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Oct 02, 2020
8 min read

Aripiprazole: everything you need to know

Aripiprazole belongs to the antipsychotic drug class and is mainly used to treat psychosis, including delusions, hallucinations, paranoia, or disordered thinking. Psychosis is typically associated with schizophrenia but is also found in other mental health disorders.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

What is aripiprazole, and how does it work?

Aripiprazole is a prescription medication used to treat certain mental health conditions, like schizophrenia and bipolar disorder. It’s available as a generic drug and under the brand names Abilify and Aristada. 

Aripiprazole belongs to the antipsychotic drug class and is mainly used to treat psychosis, including delusions, hallucinations, paranoia, or disordered thinking. Psychosis is typically associated with schizophrenia but is also found in other mental health disorders. 

Aripiprazole is considered an atypical antipsychotic, meaning it is a second-generation antipsychotic. Atypical antipsychotics are less likely to cause movement disorder side effects, whereas typical antipsychotics, like haloperidol or chlorpromazine, have a higher risk of side effects. Atypical antipsychotic drugs, like aripiprazole, restore the balance of dopamine and serotonin in the brain to improve thinking, behavior, and mood. Other examples of atypical antipsychotics include clozapine, ziprasidone, risperidone, quetiapine (brand name Seroquel; see Important Safety Information), and olanzapine. 

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What is aripiprazole used for?

Aripiprazole is FDA approved to treat the following conditions (FDA, 2016):

  • Schizophrenia
  • Manic and mixed episode of bipolar disorder
  • Major depressive disorder (MDD)
  • Autistic disorder
  • Tourette’s disorder

Schizophrenia

Schizophrenia is a mental illness that affects how a person thinks, feels, and interacts with the world around them. It typically starts gradually in the late teens to early 30s with changes in thinking, mood, and behavior. Psychosis may develop later. Symptoms of psychosis include (NIMH, 2020): 

  • Hallucinations (seeing or hearing things that aren’t there)
  • Delusions (firmly held beliefs that are not supported by facts, like paranoia)
  • Disorganized thinking

Other signs of schizophrenia include “negative” symptoms, like lack of motivation or feelings of pleasure and a “flat affect” (little to no emotional expression in face or voice) (NIMH, 2020). 

Left untreated, the symptoms of schizophrenia can make it difficult for a person to engage with others, achieve independence, or form meaningful relationships. Fortunately, there are treatments available. Aripiprazole and other antipsychotic drugs can help people with schizophrenia, especially when combined with psychosocial treatments (like cognitive behavioral therapy).

Manic and mixed episodes of bipolar disorder

Bipolar disorder is a condition that causes unusual shifts in moods, sometimes between periods of extremely energized behavior (known as manic episodes) and very sad or hopeless periods (known as depressive episodes). This manic-depressive form is also called bipolar I disorder. Mixed episodes in bipolar disorder refer to having both manic symptoms and depressive symptoms at the same time. 

Treatment for bipolar disorder is usually lifelong and often includes mood stabilizers (like lithium or valproate) and antipsychotics, like aripiprazole. Aripiprazole can help treat a current manic or mixed episode or for maintenance (long-term) therapy of bipolar disorder. Psychotherapy (or “talk therapy”) may also play a vital role in the treatment of this condition, along with the medical treatments (NIMH, 2020). 

Major depressive disorder (MDD)

Major depressive disorder (often simply called depression) is one of the most common mental health disorders in the U.S. (NIMH, 2018). Depression can affect all aspects of your life and is more than just “feeling sad.” Common symptoms of depression include (NIMH, 2018):

  • Feelings of helplessness, guilt, or worthlessness
  • Loss of pleasure or interest in usual hobbies and activities
  • Feeling tired all of the time
  • Difficulty concentrating
  • Angry outbursts or irritability
  • Feeling hopeless, sad, or anxious
  • Decreased or increased weight and appetite changes
  • Sleeping too much or trouble sleeping (insomnia
  • Unexplained physical problems, like stomach issues or headaches
  • Frequent thoughts of death or suicide, or suicide attempts

It is not uncommon to experience these feelings occasionally or for a brief time, often in response to life stressors. However, you may have depression if you are experiencing any of these symptoms for most of the day, almost every day, for two weeks or more. Treatment of depression usually involves medication, psychotherapy, or some combination of therapies (NIMH, 2018). When used along with other antidepressants, aripiprazole may help improve the symptoms of depression in people who did not get better with their previous antidepressant treatment (e.g., paroxetine [brand name Brisdelle; see Important Safety Information], venlafaxine [brand name Effexor XR; see Important Safety Information], fluoxetine [brand name Prozac; see Important Safety Information], escitalopram [brand name Lexapro; see Important Safety Information], or sertraline [brand name Zoloft; see Important Safety Information]) (DailyMed, 2020).

Autistic disorder

Autism is a spectrum of disorders that range from mild to severe and affect communication and behavior—the medical term is autism spectrum disorder (ASD). Symptoms usually begin in the first two years of life, but autism can be diagnosed at any age. In general, people with ASD may have trouble communicating and interacting with others, exhibit repetitive behaviors, have restricted interests, and have difficulty functioning in school, work, and other aspects of daily life (NIMH, 2018). 

Treatment of autism spectrum disease may include behavioral, psychological, and educational therapy with or without medications. Medications may help people who experience irritability, aggression, repetitive behavior, hyperactivity, attention problems, anxiety, or depression as part of their ASD. Aripiprazole may help decrease the irritability, hyperactivity, and repetitive actions associated with autism spectrum disorder (Gettu, 2020).

Tourette syndrome

Tourette syndrome is a nervous system disorder that causes sudden twitches, movements, or sounds (called tics). People with Tourette syndrome cannot control these tics, as much as they may want to. There is no cure for this condition, and for most people, their tics do not get in the way of their everyday activities. However, some may experience tics that cause pain, interfere with their school/work/social life, or cause stress. For these people, medications may be an option. Aripiprazole may help reduce the number, frequency, intensity, and/or complexity of tics, allowing people to improve their daily life and activities. 

Off-label

Sometimes healthcare providers use aripiprazole “off-label”—this means that the FDA hasn’t approved aripiprazole to treat that specific condition. Examples of “off-label” uses for aripiprazole include treatment for agitation/aggression associated with substance abuse or dementia. Dementia is a brain disorder, usually in older people, that affects the ability to remember, think clearly, communicate, and perform daily activities. In some people, dementia can cause changes in personality and mood, including agitation and aggression. Taking aripiprazole may help with these mood changes. However, it may also increase the risk of stroke and mental function decline.

Side effects

Black box warning from the U.S. Food and Drug Administration (FDA, 2016): Older people with dementia-associated psychosis should avoid taking antipsychotics like aripiprazole because of the increased risk of strokes, mental function decline, and even death. Aripiprazole may also increase the risk of suicidal thoughts and behaviors, especially children, teenagers, or young adults. Families and caregivers should be aware of this risk and look out for suicidal thoughts, attempts, or other mood changes.

Common side effects include (DailyMed, 2020): 

  • Nausea
  • Vomiting
  • Constipation
  • Headache
  • Dizziness, lightheadedness, or loss of balance
  • Agitation and restlessness
  • Anxiety
  • Insomnia
  • Sleepiness or fatigue
  • Increased appetite
  • Weight gain
  • Dry mouth or increased salivation
  • Heartburn 

Serious side effects include (DailyMed, 2020):

  • Strokes
  • Increased thoughts of suicide, especially in younger people
  • Neuroleptic malignant syndrome (NMS): a life-threatening reaction that causes high fever, muscle stiffness, changes in mental function (like delirium or confusion), high blood pressure, and elevated heart rate.
  • Tardive dyskinesia: repetitive, involuntary movements of the face or body (e.g., grimacing, eye blinking, mouth movements) 
  • Elevated blood sugars (hyperglycemia)
  • Compulsive behaviors: pathological gambling, compulsive or binge eating, compulsive shopping, and compulsive sexual urges
  • Low blood pressure (hypotension), especially when you stand from a sitting position (orthostatic hypotension)
  • Low white blood cell count
  • Seizures

This list does not include all possible side effects of aripiprazole, and others may occur. Seek medical advice from your pharmacist or healthcare professional for more information. 

Drug interactions

Tell your healthcare provider about any other drugs you may be taking before starting aripiprazole, including over-the-counter medications and herbal supplements. Potential drug interactions include (DailyMed, 2020):

  • Drugs that affect the CYP3A4 or CYP2D6 systems: The liver’s CYP3A4 & CYP2D6 systems break down aripiprazole. Medications that affect these systems alter the effective levels of the drug in your body. Medicines that block either CYP3A4 or CYP2D6 prevent aripiprazole from being metabolized. This causes more of the drug than expected to be in your system and increases your risk of side effects. Examples of these drugs include itraconazole, clarithromycin, quinidine, fluoxetine, and paroxetine. On the other hand, drugs that increase the activity of the CYP3A4 or CYP2D6 systems break down aripiprazole faster than expected, making your dose less effective; examples include carbamazepine and rifampin. If you are taking any medications that affect the CYP3A4 or CYP2D6 systems, your healthcare provider may adjust your aripiprazole dose.
  • Benzodiazepines: Benzodiazepines (like lorazepam) are often used to help treat anxiety. However, taking benzodiazepines with aripiprazole may cause more sedation (sleepiness) and orthostatic hypotension (low blood pressure) than with either drug alone.

This list does not include all possible drug interactions with aripiprazole, and others may exist. Check with your pharmacist or healthcare provider for more information.

Who should not take aripiprazole (or use with caution)?

Certain groups of people should avoid using aripiprazole or use it with caution and careful monitoring because of their higher risk of side effects. Examples of these groups include (UpToDate, n.d.):

  • Pregnant or Nursing Women: According to the FDA, aripiprazole is Pregnancy Category C, meaning that there is not enough data to say whether or not aripiprazole is safe during pregnancy (FDA, 2016). However, if taken in during the third trimester, newborns are at risk for developing withdrawal symptoms or extrapyramidal symptoms. Aripiprazole does enter breast milk. Before taking aripiprazole, women and their healthcare providers should look at both the potential risks to the baby and the benefits to the mother.
  • People under 18 years of age: Younger people are at an increased risk of suicidal thoughts or behaviors while taking aripiprazole.
  • Older adults with dementia-related psychosis: People over the age of 65 with dementia-related psychosis have an increased risk of death with aripiprazole. They also have a higher risk of developing strokes.
  • People with high blood sugars or diabetes: Aripiprazole may increase blood sugars, leading to ketoacidosis, coma, or death in extreme cases. 
  • People with Parkinson’s disease: Aripiprazole can worsen motor function in people with Parkinson’s disease. 
  • People with seizures: Aripiprazole can increase the risk of seizure, and should be used with caution in people who have a history of seizures. 
  • People with a severe allergic reaction to aripiprazole (e.g., skin rash, itching, hives, trouble breathing, etc.) should not take aripiprazole.

This list does not include all possible at-risk groups, and others may exist. Talk to your healthcare professional or pharmacist for more information. 

Dosing

Aripiprazole is available as both a generic pill or under the brand names Abilify and Aristada. It comes as a tablet, an oral solution, an injection, or a disintegrating tablet and is usually taken once daily. Aripiprazole also comes as a tablet with a built-in sensor (Abilify MyCite) so that your healthcare provider can monitor how you are taking the drug. Aripiprazole tablets are available in 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg strengths, while the disintegrating tablets are only available in 10 mg and 15 mg strengths. 

Many insurance plans cover aripiprazole, and the cost for a 30-day supply can range from $9 to over $300 for the generic medication. The brand name Abilify tablets can cost over $1000 at some pharmacies (GoodRx.com).

References

  1. Centers for Disease Control and Prevention (CDC). (2020). What is Tourette Syndrome?. Retrieved on September 18, 2020 from https://www.cdc.gov/ncbddd/tourette/facts.html
  2. DailyMed. (2020). Aripiprazole tablet. Retrieved on September 18, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3988e66f-339c-451e-9f8a-9d0c0a2a381b
  3. Gettu, N., Saadabadi, A. (2020). Aripiprazole. [Updated Sept. 17, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547739/
  4. GoodRx.com. (n.d.). Aripiprazole. Retrieved September 18, 2020 from https://www.goodrx.com/aripiprazole
  5. MedlinePlus. (2019). Aripiprazole. Retrieved on September 18, 2020 from https://medlineplus.gov/druginfo/meds/a603012.html
  6. National Institute of Mental Health (NIMH). (2018). Autism spectrum disorder. Retrieved on September 18, 2020 from https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml#part_145436
  7. National Institute of Mental Health (NIMH). (2020). Bipolar-Disorder. Retrieved on September 18, 2020 from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  8. National Institute of Mental Health (NIMH). (2018). Depression. Retrieved on September 18, 2020 from https://www.nimh.nih.gov/health/topics/depression/index.shtml
  9. National Institute of Mental Health (NIMH). (2020). Schizophrenia. Retrieved on September 18, 2020 from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
  10. UpToDate. (n.d.). Aripiprazole: Drug information. Retrieved on September 18, 2020 from https://www.uptodate.com/contents/aripiprazole-drug-information
  11. U. S. Food and Drug Administration (FDA). (2016). Abilify (aripiprazole) Tablets, USP. Retrieved on September 18, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021436s041,021713s032,021729s024,021866s026lbl.pdf