Abilify is the trade name of aripiprazole, which is an atypical antipsychotic drug whose main mechanism of action involves the regulation of dopamine and serotonin levels in the brain. The medication comes in the form of tablets, orally dissolving tablets, solution, and injection. Abilify is used in the treatment of some psychiatric disorders and nervous system diseases such as schizophrenia, bipolar I disorder, depression, irritability caused by autistic disorder, and Tourette’s disorder. An intramuscular formulation of the drug is also indicated for acute agitation in patients with schizophrenia or bipolar mania. As Abilify may result in movement disorders, metabolic problems, cardiovascular complications, and behavioral side effects, it should be prescribed cautiously.

Important Warnings while taking Abilify

A boxed warning has been provided in relation to the increased risk of death due to aripiprazole in elderly patients with dementia-related psychosis. Some medications contain antipsychotic drugs that have been found to increase mortality risk among patients with dementia-related psychosis, and Abilify is one of them. These patients have been known to experience cerebrovascular events such as stroke and transient ischemic attacks.

Other warnings in relation to Abilify relate to increased thoughts of suicide among those using the drug. This applies to cases where Abilify is administered in combination with an antidepressant as part of treatment for major depressive disorder. The patients who have to be closely observed include those aged from childhood to young adulthood.

Akathisia is another side effect related to Abilify administration. It involves the presence of restlessness and a desire to move about. Other side effects relating to movement include tremors, extrapyramidal symptoms, dyskinesia, and dystonia.

The drug can have effects on metabolism, and patients may experience alterations in blood glucose, cholesterol, triglycerides, and weight gain. If there are any risk factors for developing diabetes, blood glucose levels may be monitored. In addition, there may be orthostatic hypotension, dizziness, syncope, and altered judgment and physical coordination, especially during initiation of treatment or alteration in dose of the drug.

Some other adverse reactions include neuroleptic malignant syndrome, convulsions, trouble swallowing, and development of compulsive behavior such as pathological gambling or overeating, over-shopping, or hypersexuality.

Things to consider before Abilify consumption

• Allergies
• Schizophrenia, bipolar disorder, or depression
• Diabetes or blood sugar problems
• Heart disease or low blood pressure
• Seizure disorders
• Movement disorders
• Liver or kidney problems
• Dementia
• History of compulsive behaviors
• Pregnancy and breastfeeding
• Alcohol and other medicines
• Age and overall health

This is because Abilify is known to have an impact on the nervous system, the cardiovascular system, the metabolic state, and movement regulation. Those who have diabetes mellitus or a predisposition to it may need to monitor their blood sugar levels; those who have cardiovascular disease or low blood pressure may be susceptible to dizziness or fainting. The patients should inform the doctor about a history of seizures or movement disorders.

Moreover, the patient's liver and kidney functions can be a factor to consider in terms of therapy, especially when taking other medications. There is no use of Abilify in treating patients suffering from dementia-associated psychosis because of the risk of increasing their mortality due to the use of antipsychotics among older patients. It is necessary to consult with a healthcare provider regarding pregnancy and breastfeeding because of the possible negative consequences of antipsychotics for a fetus.

Medications that cause drowsiness, as well as alcohol, should be avoided, as some side effects of aripiprazole can be exacerbated. Some medicines that either inhibit or induce CYP2D6 and CYP3A4 can affect the exposure to Abilify and may require dose adjustment. The patient should disclose any history of unusual or out-of-control behaviors because Abilify has been associated with compulsive behaviors.

Application/Consumption

The doses of oral formulations of Abilify are taken once a day, regardless of meals. The dose depends on the disease, patient's age, tolerance of treatment, additional medications, and risk factors. Oral tablets of the drug are consumed as per prescription, but disintegration formulations should be consumed as directed by the doctor.

Abilify is prescribed to be used alone or in combination with other medications. This drug can be an add-on therapy in the treatment of major depressive disorder with antidepressants or with lithium or valproate for some patients with bipolar I disorder. It is forbidden to increase or decrease the dose independently or stop the treatment, since any changes in dosing of the psychiatric medicines lead to a worsening of symptoms.

Abilify also comes in long-acting injection formulations. Abilify Maintena is an extended-release formulation, which is administered intramuscularly in cases of schizophrenia in adults and bipolar I disorder maintenance treatment. Another extended-release formulation of this medication, called Abilify Asimtufii, is administered once every two months in adults with schizophrenia and as maintenance monotherapy for bipolar I disorder. These injections should be administered only by a healthcare provider. Patients who have never taken Abilify should first undergo oral Abilify treatment to prove tolerability before beginning certain long-acting injectable treatments.

Dosing information

Abilify dosing varies substantially depending on the condition and formulation.

The appropriate initial and maintenance dosage of Abilify varies depending on the specific condition being treated, patient age, and individual clinical response.

Uses

Abilify is used for:

• Schizophrenia: It is used to treat schizophrenia in adults and certain pediatric patients.
• Bipolar I disorder: It is used for acute manic and mixed episodes and, with appropriate formulations, maintenance treatment.
• Major depressive disorder: It can be used as an adjunct to antidepressant therapy in adults whose response to antidepressant treatment alone is inadequate.
• Irritability associated with autistic disorder: Oral aripiprazole is used in pediatric patients for irritability associated with autistic disorder.
• Tourette’s disorder: It is used to treat symptoms associated with Tourette’s disorder.
• Acute agitation: Intramuscular aripiprazole is used for agitation associated with schizophrenia or bipolar mania.

Abilify is not approved for treating behavioral symptoms of dementia-related psychosis in elderly patients.

Abilify side effects

Side effects are different based on what illness is being treated. They may include akathisia, restlessness, insomnia, nausea, constipation, fatigue, dizziness, and headache. For patients with schizophrenia, akathisia has been known to be one of the most reported side effects. In bipolar disorder, akathisia, sedation, restlessness, tremor, and extrapyramidal side effects may occur. For patients with depression who are using Abilify as an adjunctive therapy, the side effects that have been reported include akathisia, restlessness, insomnia, constipation, fatigue, and blurred vision.

Another aspect worth considering is the issue of weight gain and metabolism. It may include a change in appetite, body weight, blood sugar levels, and lipids. For people suffering from diabetes and at risk of developing diabetes, they may need to have their blood sugar checked periodically, along with other metabolic variables.

Abilify may cause movement disorders including tremor, rigidity, abnormal involuntary movements, dystonia, and akathisia. One side effect which is possibly irreversible is tardive dyskinesia; it is characterized by repetitive and involuntary movements that may appear when patients are taking antipsychotic medicines.

One of the possible side effects of Abilify is orthostatic hypotension, which implies that blood pressure may drop when patients stand up. This side effect may lead to fainting, dizziness, or light-headedness. Therefore, patients should exercise caution when rising from a lying-down position rapidly. They should especially pay attention during the first days of taking Abilify or if there was a dose increase recently.

Another serious but quite rare side effect of Abilify is neuroleptic malignant syndrome (NMS). This is a rare life-threatening medical condition characterized by high fever, muscle stiffness, mental status change, sweating, and irregular heart rate or blood pressure. 

Abilify is known to provoke compulsive or uncontrollable behaviors as well. These might include gambling, excessive food intake, shopping, or unusual sexual urges. Patients may have no prior history of these behaviors.

Seizures might occur but are rare. Patients with a past medical history of seizures or diseases causing reduction of the seizure threshold should be monitored more carefully.

Abilify can have an interaction with medications that have an influence on the CYP2D6 and CYP3A4 enzyme systems. A potent inhibitor will raise the exposure to aripiprazole, while a potent inducer of the CYP3A4 system will reduce the exposure. Dose adjustment is required for such medications.