Abilify (Aripiprazole): Uses, Side Effects, Dosage, & More

What Is Abilify?

Abilify, the brand name for aripiprazole, is an atypical (second-generation) antipsychotic used for the treatment of several mental health conditions. Abilify shows reduced extrapyramidal side effects (EPS) (e.g. continuous spasms and muscle contractions, irregular/jerky movements) compared to first-generation antipsychotics. Abilify can cause a side effect of orthostatic hypotension (a decrease in blood pressure after standing up).

Abilify is FDA-approved for ages six years and older based on the indication. FDA approval means the manufacturer has demonstrated the effectiveness and safety of Abilify to the FDA, and the FDA has responded by approving it.¹

How Does Abilify Work?

The primary mechanism of action of Abilify is unknown. However, it is believed to work through multiple nerve pathways in the brain. Abilify works on different chemicals in the brain, like serotonin and dopamine, improving symptoms of schizophrenia, bipolar disorder, and major depression. Abilify helps stabilize these chemicals to improve mood swings, hallucinations, and irritability.¹

Are Abilify & Xanax the Same?

Abilify and Xanax (alprazolam) are not in the same medication class. Xanax is a benzodiazepine and is indicated for the treatment of general anxiety disorder and panic disorder in adults. The mechanism of action works by binding to the benzodiazepine site of GABA receptors in the brain. Xanax should be used with caution in patients with depression to avoid intentional overdose. There has been an association between Xanax, panic disorder, and major depression with increased rates of suicide in this population.^1,2

Is Abilify Good for Anxiety?

Anxiety can be a side effect of Abilify, occurring in about 17% of patients on this medication. Patients, caregivers, and their providers should be aware of the signs of increasing anxiety. There have not been many research studies looking at the effectiveness of Abilify to treat anxiety. For treatment-resistant anxiety (failed other anxiety medications), atypical antipsychotics may improve symptoms. Safety and effectiveness of Ability in anxiety should be further researched.^1,3

Vraylar Vs Abilify: How Do They Compare?

Vraylar (cariprazine) and Abilify are both atypical antipsychotics, having similar effectiveness profiles. They are both used to treat bipolar disorder, schizophrenia, and major depression. They are both dosed similarly and show similar side effects. Vraylar is not approved for use in pediatric patients. Abilify is not approved for children with depression, but approval has been granted for other conditions, including bipolar disorder, Tourette syndrome, and autism.

Vraylar has late-occurring side effects, where side effects can occur several weeks following the start of therapy. Both Vraylar and Abilify have boxed warnings (the most serious FDA warning) for elderly patients with dementia-related psychosis, which have an increased risk of death in this population.^1,4

What Is Abilify Used to Treat?

Abilify is used to treat schizophrenia, bipolar disorder, major depression, and irritability associated with autism. These are the FDA-approved indications acquired through research and clinical trials showing effectiveness in specific populations. Abilify is used for children aged six years and older for irritability associated with autistic disorder. Abilify use has shown variable side effects between patients, and it is not unlikely to see one antipsychotic discontinued to begin a different antipsychotic regimen.¹

Abilify has also been prescribed for off-label uses. The term “off-label use” is a common occurrence in medical practice where a medication has not been FDA-approved for a medical indication but can be helpful to patients who have that condition. The prescriber will use their clinical judgment for off-label use. Abilify has been utilized off-label for borderline personality disorder, acute agitation associated with psych disorders, and Tourette Syndrome (TS). In acute agitation episodes in patients with schizophrenia, Abilify significantly improved the main symptoms of acute schizophrenia.^1,5

Common Side Effects of Abilify

Common side effects of Abilify may include dizziness, vomiting, tremors, and weight gain. Sexual side effects of Abilify are also possible. Common side effects generally do not require immediate medical attention; however, it is important to recognize worsening of symptoms. If these symptoms were to persist or increase in severity leading to uncontrollable movement, irregular heartbeat, or severe changes in mental status, then it is important to seek immediate medical attention.

Common side effects of Abilify include:*¹

• Nausea
• Constipation
• Headache
• Akathisia
• Anxiety
• Insomnia
• Restlessness

*All medications, including Abilify, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Does Abilify Cause Weight Gain?

Abilify is in a class of medications that can cause weight gain. The adult research trials show minimal weight gain compared to placebo (any treatment that has no active properties, such as a sugar pill). Abilify has less effect on weight gain compared to other first-generation antipsychotics (e.g. haloperidol). Pediatric patients are at an increased risk for more significant weight gain.^1,3

Serious Side Effects of Abilify

The serious side effects of Abilify include serious mood changes, uncontrollable movement, high fever, and irregular heartbeat. These symptoms should prompt the patient to seek additional medical attention to further evaluate therapy.¹

Serious side effects of Abilify include:*¹

• Severe dizziness
• Confusion
• Fast or irregular heartbeat
• Uncontrollable movements
• Muscle stiffness
• High fever
• Severe mood changes

*All medications, including Abilify, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Abilify Warnings & Precautions

Abilify carries a boxed warning, the most severe warning from the FDA, for an increased risk of suicidal thoughts and behavior. Patients who have a history of depression should be monitored closely for unusual or worsening behavior. Neuroleptic malignant syndrome (NMS) may have severe symptoms of muscular rigidity and fever. This is a rare but potentially fatal side effect.¹

An additional side effect that is irreversible is tardive dyskinesia (TD). TD is a movement disorder that causes a range of repetitive muscle movements in the face, neck, arms, and legs. This is notably highest in elderly patients and more prevalent in patients who have been taking this medication for a long time. Seizures, cognitive impairment, and motor impairment associated with Abilify may also need medical attention. Abilify may also cause blood count abnormalities (e.g. leukopenia, neutropenia, and agranulocytosis) in patients.¹

Use precaution when taking Abilify if you:¹

• Are diagnosed with seizure disorders: Patients who are taking medications for seizures may see a rise in the number of seizures.
• Have a history of low blood cell count: Patients who have been told they have low white blood cells or experienced drug-induced leukopenia/neutropenia should be closely monitored.
• Have a history of depression: Patients with a history of depression are at an increased risk for suicidal thoughts and behaviors.
• Neuroleptic malignant syndrome: This is a rare but very serious warning as it can be fatal. Patients should be aware of symptoms, including increased fever, altered mental status, and autonomic instability.
• Become pregnant or are breastfeeding: Abilify may be excreted during breastfeeding, and it is recommended to keep your provider informed of pregnancy status. Do not breastfeed while taking Abilify.
• Have been diagnosed with Alzheimer’s dementia: This is a boxed warning (the most severe warning by the FDA) to have an increased risk of suicidal thoughts and behaviors and should never be administered to any patients with dementia.

Abilify Dosages for FDA-Approved Treatment

Abilify dosage is based on the patient’s condition. In adults 18 and older who are being treated for depression, the initial dose is typically 2-5 mg/day. Irritability associated with autistic disorder in pediatric patients will see the 2-5 mg/day dose. Schizophrenia and bipolar disorder in adults are treated with a starting dose of 10-15 mg/day. Bipolar disorder in the pediatric population is treated with a starting dose of 2 mg/day.¹

This medication is approved for the treatment of irritability associated with autistic disorder for ages 6 and up. Schizophrenia-approved age ranges are age 13 and older, while the acute treatment of bipolar disorder ranges from age 10 and up. The injection is typically used for the acute treatment of agitation associated with bipolar or schizophrenia. The intramuscular (into the muscle) injection has a maximum daily dose of 30 mg while waiting at least 2 hours in between doses.

Prescribers should use the lowest effective dose possible, with the maximum daily dose being 30 mg/day for all approved conditions, except the maximum dose of 15mg/day when used as adjunctive treatment with antidepressants or for irritability associated with autistic disorder.¹

Abilify Forms & Strengths

Abilify comes in different formulations to increase adherence based on an individual’s needs. The correct formulation and strength are determined based on age and condition of the patient. The approved forms of Abilify include oral tablets, oral disintegrating tablets, oral solution, and an intramuscular injectable. Prescribers will also take the patient’s abilities, past history of substance use, and the severity of the condition into consideration.¹

Prescribers will aim to use the lowest effective dose. Abilify is taken once daily, and the dose may change based on the patient’s symptom response. It may take several weeks to see the full effects. However, side effects usually appear within the first week.¹

Abilify is available in the following forms and strengths:¹

• Oral tablet: 2 milligrams (mg), 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
• Oral disintegrating tablet: 10 milligrams (mg), 15 mg
• Oral solution: 1milligrams (mg)/milliliter (mL) oral solution
• Injection for intramuscular use: Ready-to-use 9.75 milligram (mg)/1.3 milliliter (mL) intramuscular injection (7.5mg/1mL)

What’s the Most Effective Dose of Abilify?

The most effective dose of Abilify will vary from patient to patient based on the indicated condition, and age of the patient. This medication typically undergoes a dose titration (slow dose increase or decrease) based on the response the patient is having to the medication. This is where the healthcare team, caregiver, and patient all utilize shared decision making to ensure the best outcome for the patient.¹

How Long Does it Take for Abilify to Work?

How long Abilify takes to work can vary for patients. Some patients may experience effects within a few days, while others may not see the benefits of the medication for many weeks (up to 8-12 weeks). The injection will typically start to work faster than the oral formulations of Abilify.¹

How Should I Take Abilify?

Abilify should be taken as directed by your healthcare provider. Abilify is typically dosed once a day with or without food and should be continued at the same time each day. Oral disintegrating tablets should be handled carefully with dry hands. The tablets will come in a package with a foil blister. It is important to pull the foil back. Do not force push the tablet through.

The disintegrating tablet is then placed on the tongue and allowed to dissolve quickly in saliva. Do not split this tablet. Do not use liquid to swallow unless absolutely needed following the disintegrating tablet. Take this medication directly as prescribed.¹

What Happens If I Miss a Dose of Abilify?

If you miss a dose, Abilify should be taken as soon as the patient remembers they have forgotten the dose unless they are close to the next dose scheduled. It is important not to double up the dose of this medication and to skip the previous dose if it is close to the next dosing time. If there are consistent missed doses, this can result in severe side effects (e.g. nausea, increased heart rate, lightheadedness, headaches, tremors, flu-like symptoms, and anxiety).¹

Can You Overdose on Abilify?

Yes, you can overdose on Abilify. Signs of an overdose can include uncontrolled movements, vomiting, and somnolence. An irregular heartbeat, aggression, and altered mental status may also be seen in overdose incidents.¹

What Should You Do If You Take Too Much Abilify?

If you take too much Abilify, remain calm and dial 911. You may also call the Poison Control Center (800-222-1222) for advice. If you arrive at the emergency room, they will monitor your heart and oxygen level.¹

What to Avoid When Taking Abilify

Abilify works on the brain and therefore has the ability to cause harmful interactions with similar-acting agents. Dizziness and motor impairment can be seen more often when administered with the addition of these substances. Abilify may also have interactions with some blood pressure medications.¹

6 substances you should avoid while taking Abilify include:

• CYP3A4 Inducers (e.g. carbamazepine): Carbamazepine increases the clearance of Abilify to lower the blood levels and lower the effectiveness of Abilify.
• CYP2D6 Inhibitors (e.g. quinidine): Quinidine decreases the clearance of Abilify, increasing the amount of Abilify in your body, which may increase the risk of side effects
• CYP3A4 Inhibitors (e.g. ketoconazole): Ketoconazole decreases the clearance of Abilify, increasing the amount of Abilify in your body, which may increase the risk of side effects
• Grapefruit juice: Grapefruit decreases the clearance of Abilify, increasing the amount of Abilify in your body, which may increase the risk of side effects
• Alcohol: Using alcohol and Abilify together may increase some of Abilify’s side effects, like dizziness and irritability
• Benzodiazepines (e.g. Xanax): Sedation (excessive tiredness) is increased with the combination of Abilify and benzodiazepines, such as Xanax. Decreased blood pressure after standing up is also possible with the combination.

Risks of Abrupt Discontinuation

Abruptly stopping Abilify can lead to potentially harmful side effects. This could include withdrawal symptoms, irritability, and worsening symptoms. Withdrawal symptoms include restlessness and anxiety. It is vital to always be in communication with your prescriber and pharmacist while on Abilify. If you decide to stop Abilify, the provider will design a patient-specific tapering schedule (slowly decrease) to limit the side effects experienced from abrupt discontinuation.¹

How to Get a Prescription for Abilify

Abilify is a prescription-only medication. The patient must be seen and diagnosed with one of the conditions indicated for Abilify. The physician, nurse practitioner, physician assistant, and psychiatrist are a few examples of providers who will conduct a thorough examination of a medical history, symptoms, and further psychological evaluation. Your prescriber will take into account the severity and the overall benefit of the use of Abilify compared to the risks associated with the particular patient.¹

How Much Does Abilify Cost?

Abilify can range from $600 to $900 for a 30-day supply if the patient does not have insurance. Printable coupons for Abilify can be utilized in nearly 65,000 pharmacies around the United States. Patients with insurance could use the savings card to pay as little as $5 for a 30-day supply of the brand name Abilify (e.g. this excludes Medicare and Medicaid patients). There are also patient assistance & copay programs available for Abilify, where patients can check for eligibility to apply for Medicare or Medicaid.

Abilify is available in a generic form where prices are less than $30 for 30-day supplies. The oral disintegrating tablet and oral solution are much more expensive, even in the generic form.⁶

Questions to Ask Your Healthcare Provider About Abilify

Regarding Abilify, the patient should understand the risks and benefits specific to their condition. All antidepressants have the risk of increased suicidal thoughts. You should ask your doctor, psychiatrist, pharmacist, and therapist any questions you may have before starting Abilify. Online psychiatry services are ideal for patients needing to switch providers or discover other options.¹

Questions to ask your care team about Abilify include:

• How safe is Abilify?
• How does Abilify affect my health long-term?
• Will my insurance cover Abilify?
• How long will it take for this to work?
• How do I avoid the possibility of gaining weight?
• What should I do if my pharmacy has a shortage?
• Will this affect my sleep?
• Will this have interactions with any other medication I am taking?
• When do I need to reach out to you on my own?
• What happens if I accidentally forget to take my medicine?
• What are some Abilify alternatives to consider?