Aripiprazole (Abilify) Side Effects to Look For

Aripiprazole is a generic medication used for the management of mental health conditions, including bipolar I disorder, schizophrenia, and as an add-on therapy for depression. Abilify is a brand name for generic aripiprazole. Abilify can interact with other medications and certain lifestyle factors, such as alcohol intake.

Continue reading to learn more about what to expect when taking Abilify, the indications, side effects, and drug interactions.

What is aripiprazole and what does it treat?

Aripiprazole is an antidepressant drug used to treat schizophrenia, bipolar I disorder, Tourette syndrome, and autism spectrum disorder.

Aripiprazole is only approved to be used as an adjunctive treatment for adults with major depressive disorder (MDD) without psychotic symptoms. Meaning aripiprazole is used in combination with an antidepressant when depressive symptoms are not controlled by antidepressants alone.

Aripiprazole belongs to the group of medications called atypical antipsychotics. Abilify oral solution and orally disintegrating tablets work by altering the activities of certain neurotransmitters or brain chemicals in the central nervous system.

Abilify (aripiprazole) is approved to treat the following patient populations:

Schizophrenia: Abilify (aripiprazole) is approved to treat schizophrenia in adults and children 13 years and older;
Bipolar I disorder: Abilify (aripiprazole) is used alone or in combination with a mood stabilizer such as lithium or valproate to treat mania associated with bipolar I disorder in adults and children 10 years and older;
Add-on therapy for depression: Aripiprazole (Abilify) is used in combination with an antidepressant as an add-on agent to treat major depressive disorder (MDD) in adults.
Irritability associated with autistic disorder, Tourette’s disorder: Aripiprazole (Abilify) is used to control irritability, aggressive behavior, and mood swings in children 6 years and older.

This article focuses on the information of Abilify (aripiprazole) oral tablets; however, this medication is also available in different forms listed below:

Abilify Mycite: a system including an oral tablet and a sensor that logs when the oral tablet is taken;
Abilify Maintena: an extended-release intramuscular injection that is administered once monthly as a maintenance therapy in adults to make sure the bipolar symptoms remain stable;

How does aripiprazole work?

Aripiprazole (Abilify) is an atypical antipsychotic or a second-generation antipsychotic.

It works by balancing the levels of brain chemicals, such as dopamine and serotonin, in the nervous system, thereby regulating thoughts, behaviors, and actions.

The symptoms of mania and psychosis associated with schizophrenia occur due to the dopamine level imbalance in the brain's neurotransmitter.

Aripiprazole (Abilify) helps to regulate the levels of dopamine and other chemicals in the brain. It reduces the brain’s dopamine activity in areas where there is too much of it, thus relieving hyperactivity or aggressiveness associated with autism.

The favorable balance of dopamine and serotonin in the brain can also relieve the symptoms associated with paranoid schizophrenia, such as hallucinations.

Additionally, aripiprazole increases dopamine activity in the parts of the brain having a lower amount of this chemical, therefore relieving sadness, poor motivation, and suicidal tendencies in patients with bipolar disorder and depression.

Aripiprazole (Abilify) also acts as a partial agonist to serotonin receptors, thus regulating the levels of serotonin in the central nervous system.

The regulatory effect of aripiprazole on dopamine and serotonin levels can help balance the mood of the patients, thereby preventing extremes of behaviors or thoughts or fluctuating moods between low activity and hyperactivity.

What are the indications for aripiprazole (Abilify)?

Abilify is approved by the U.S. FDA (Food and Drug Administration) for the treatment of the following conditions:

Schizophrenia
Bipolar I disorder
Irritability associated with autism
Tourette’s syndrome
Depression

Healthcare professionals also prescribe Abilify Maintena, a monthly intramuscular injection, for the maintenance treatment of adults with bipolar disorder to keep the symptoms stable.

What are the mild side effects of aripiprazole (Abilify)?

Abilify (aripiprazole) may cause moderate to severe side effects. Some common Abilify side effects include nausea, headache, vomiting, insomnia, dizziness, anxiety, constipation, movement disorders, restlessness, and weight gain.

Other side effects of Abilify can include:

Restlessness
Feeling unsteady, or difficulty maintaining balance
Heartburn
Stomach pain
Blood pressure problems
Changes in appetite
Increased salivation
Tiredness
Sore throat, sneezing, and other cold symptoms

Sleepiness is a common side effect of Abilify, specifically noted in children aged 6 to 18 years.

What are the serious side effects of Abilify?

Abilify (aripiprazole) can cause a few serious side effects, some of which can lead to a long-term adverse impact on the physical and mental health of patients. These include seizures, neuroleptic malignant syndrome (NMS), and movement disorders such as tardive dyskinesia.

This medicine affects the body's metabolic functions, causing side effects such as weight gain, low white blood cell counts, insulin resistance, increased cholesterol, lower blood pressure, and non-alcoholic fatty liver disease.

Abilify (aripiprazole) can cause or worsen impulse control problems and suicidal thoughts. Patients experiencing impulse control disorders while using Abilify might engage in dangerous or harmful behaviors such as compulsive gambling, compulsive shopping, and binge eating. Here are some other severe side effects of Abilify:

Difficulty breathing and swallowing
Severe skin rash and itching
Low white blood cell count
Fluctuations in blood pressure
High blood sugar
Hives on the skin
Swelling of the face, mouth, lips, tongue, eyes, hands, and feet
Changes in vision
Seizures
Uncontrollable shaking of the body arts, especially face and tongue
Stiffness of muscles
Confusion
Fast, pounding, and irregular heartbeat
Tightening of the neck muscles
Problems with muscles coordination
Tightness or swelling in the throat

Patients must notify a healthcare professional if they develop any of these serious side effects. However, the use of this drug should not be stopped abruptly.

Stopping Abilify treatment abruptly may cause withdrawal symptoms such as panic attacks, anxiety, and excessive sweating.

Abilify warning and precautions

Black box warning for elderly patients with dementia

The drug label on Abilify has a boxed warning stating that elderly patients with dementia who use this drug are at higher risk of death.

Clinical trials have revealed that elderly patients with dementia-related psychosis using Abilify are at higher risk of mortality than those in the control group.

Multiple factors associated with dementia-related psychosis, such as old age and pre-existing comorbidities like a stroke, cardiovascular events such as heart attacks, and serious infections such as pneumonia, could be implicated as possible factors contributing to the risk of mortality.

The safety and efficacy of using Abilify (aripiprazole) in elderly with psychosis associated with Alzheimer’s disease has not been established. Abilify (aripiprazole) should be used with extreme caution in this patient population. Especially in patients with difficulty swallowing, excessive somnolence can increase the risk of choking and aspiration.

Neuroleptic malignant syndrome

NMS (neuroleptic malignant syndrome) is a life-threatening reaction associated with the use of antipsychotic drugs, including Abilify.

NMS is a serious condition that causes muscle rigidity and altered mental status. Patients must notify their doctor immediately or visit a poison control center if they develop any of the following signs and symptoms:

Change in blood pressure and heart rate
Confusion
Stiff muscle
Fever
Excessive sweating

Tardive dyskinesia

Tardive dyskinesia is another serious side effect of Abilify. It causes involuntary muscle movements in all parts of the body, particularly in the lower face.

Tardive dyskinesia is more common in patients who use Abilify for several months or years, although it can manifest within six weeks of beginning the treatment.

Tardive dyskinesia usually goes away after stopping the use of Abilify. However, in some cases, the symptoms persist for several years.

Weight gain

Weight gain is a commonly noted side effect of Abilify, particularly in children. Abilify can sometimes cause weight gain in adults, although the total weight gain is less significant than that in children.

Withdrawal symptoms

As Abilify affects the balance of dopamine and serotonin in the brain, stopping the drug suddenly can cause withdrawal symptoms.

The withdrawal symptoms are more severe when the drug is stopped suddenly after long-term use or if it was used in high doses.

Abilify withdrawal symptoms include:

Panic attacks
Anxiety
Appetite changes
Diarrhea
Dizziness
Concentration problems
Confusion
Depression
Hallucinations
Headache
Sweating
Vomiting

Hence, your healthcare professional might recommend tapering off the dose of Abilify before stopping it completely to avoid withdrawal symptoms.

Orthostatic hypotension

Orthostatic hypotension is a drastic drop in blood pressure from getting up quickly from sitting or lying down. Abilify (aripiprazole) can cause changes in blood pressure and heart beat. This change in blood pressure can cause dizziness, lightheadedness, or make you feel like you may faint. To avoid dizziness that could lead to falls and injury, you should get up slowly from sitting or lying down, especially during the first week of taking this medication.

Side effects of Abilify: frequently asked questions

Does Abilify cause high blood pressure?

Abilify can cause high or low blood pressure and heart function by modifying the activities of the autonomic nervous system. It may also cause low blood pressure when standing quickly after sitting or lying down, which can result in lightheadedness.

Is Abilify safe for the treatment of major depressive disorder?

Abilify may be used in combination with an antidepressant to treat depression when symptoms persist or cannot be relieved even after the use of other antidepressant drugs.

Is Abilify safe to use during pregnancy?

The effect of Abilify on the fetus or newborn baby when used by women during pregnancy and breastfeeding is not clearly known. There is no evidence proving the safety of this medication when used by pregnant women.

Hence, women who are pregnant, breastfeeding, or planning a pregnancy should not use this drug unless advised by a healthcare professional.

What happens if I miss a dose of aripiprazole?

Patients are advised to take the doses of this medication at fixed times every day. If you miss a dose of aripiprazole, you can take it soon after you remember.

However, it is not advisable to take two doses of this drug too close to each other. Therefore, if it is almost time for the next dose, you may skip the missed dose and continue the regimen from the next dose.

What happens if I overdose aripiprazole?

Taking a higher dose of aripiprazole than prescribed causes serious adverse reactions.

The following symptoms may occur due to an overdose of aripiprazole:

Extreme drowsiness
Seizures
Weakness
Nausea
Vomiting
Loss of consciousness
Confusion

What special precautions should I follow?

Inform the doctor if you have had allergic reactions to aripiprazole or other antipsychotic medications before taking Abilify.
Share a list of all prescription and non-prescription medications you are taking with your doctor, including nutritional supplements.
Inform your doctor if you have a history of cerebrovascular disease, high blood sugar, heart failure, an irregular heartbeat, hypertension, a stroke, seizures, ischemic heart disease, mental illness, reduced white blood cells, high cholesterol, difficulty in maintaining balance, or any condition that causes difficulty swallowing. This will help you avoid the risk of drug interactions between Abilify and other medications they are using.
Tell your doctor if you have ever used street drugs or misused prescription medications or alcohol.

What should I avoid while taking antipsychotic medications?

Grapefruit juice can interact with aripiprazole causing serious side effects. Hence, patients using aripiprazole should avoid drinking grapefruit juice.