What is Abilify, and how does it work (mechanism of action)?
Abilify (aripiprazole) is an anti-psychotic medicine used for the medical treatment of psychotic conditions and disorders such as schizophrenia and bipolar disorder. It also is used with other medications for the treatment of major depression in adults.
The exact mechanism of action of Abilify is unknown. However, like other anti-psychotics, it blocks receptors on nerves in the brain for several neurotransmitters (chemicals that nerves use to communicate with each other). It is thought that its beneficial effect is due to its effects on dopamine and serotonin receptors. Its effects on these receptors are complex, involving stimulation of the receptors but to a lesser degree than the naturally-occurring neurotransmitters (a process called partial agonism).
Do I need a prescription for this medication?
Yes, you need a doctor or other medical health professional to write a prescription for it.
What are the uses for Abilify?
Aripiprazole is used for the treatment of:
- Schizophrenia
- Bipolar disorder
- Irritability associated with autistic disorder
- Tourette's disorder
- Major depression in adults (along with other medications used for the treatment of depression)
- Mixed manic/depressive episodes (as sole or adjunctive therapy) and as adjunctive (add-on) therapy for major depressive disorder
- Agitation associated with schizophrenia or bipolar mania.
Abilify warnings, side effects, and patient safety information
WARNINGS
- Long-term use of aripiprazole may lead to a potentially irreversible condition called tardive dyskinesia (involuntary movements of the jaw, lips, and tongue).
- A potentially fatal complex referred to as neuroleptic
malignant syndrome has been reported with anti-psychotic
drugs, including Abilify. Patients who develop this syndrome may have:
- High fevers
- Muscle rigidity
- Altered mental status
- Irregular pulse or blood pressure
- Rapid heart rate
- Excessive sweating
- Heart arrhythmias
- All atypical antipsychotic drugs have been associated with metabolic changes such as hyperglycemia, diabetes mellitus, dyslipidemia, and weight gain. Serious cases of hyperglycemia leading to coma or death have been reported in patients treated with atypical antipsychotics. Although there is no clear link between aripiprazole and diabetes, patients should be tested during treatment for elevated blood-sugars. Additionally, patients with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during medical treatment should be tested for diabetes.
- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death and Abilify should not be used for this indication. Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of this medicine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on medical therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.
Some of the most common side effects include:
- Anxiety
- Blurred vision
- Constipation
- Cough
- Headache
- Insomnia
- Lightheadedness
- Nausea
- Rash
- Restlessness
- Runny nose
- Sleepiness
- Tremors
- Vomiting
- Weakness
- Weight gain
What is the dosage for Abilify?
- This dose for this medication usually is once a day.
- The usual adult starting oral dose for patients with schizophrenia or bipolar disorder is 10 to 15 mg once daily. The dose may be increased over time up to 30 mg daily to achieve the desired effect.
- The recommended dose for patients with Tourette's disorder is 5 to 20 mg once daily.
Abilify drug, food (grapefruit juice), and supplement interactions
- Carbamazepine (Tegretol) can markedly decrease the amount of Abilify in the body by increasing the rate at which the body's enzymes (particularly the liver enzyme, CYP3A4) degrade it. The manufacturer recommends that patients on this drug who are started on carbamazepine double their dose of Abilify, under their doctor's supervision. Other drugs that can promote the activity of CYP3A4 and decrease the body's levels of Abilify are phenytoin (Dilantin), rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate), and phenobarbital.
-
Ketoconazole
(Nizoral) can
increase the amount of aripiprazole in the body by blocking CYP3A4. The
manufacturer of aripiprazole recommends reducing the dose of aripiprazole by
one-half during ketoconazole therapy. Many other drugs also are known to block
CYP3A4 and potentially could increase the levels of aripiprazole, but their
actual effects on aripiprazole levels have not been studied. Such drugs include:
- itraconazole (Sporanox)
- fluconazole (Diflucan)
- voriconazole (Vfend)
- cimetidine (Tagamet)
- verapamil (Calan, Isoptin)
- diltiazem (Cardizem, Dilacor)
- erythromycin clarithromycin (Biaxin)
- nefazodone (Serzone)
- ritonavir (Norvir)
- saquinavir (Invirase)
- nelfinavir (Viracept)
- indinavir (Crixivan)
- Grapefruit juice
- Quinidine (Quinaglute, Quinidex) inhibits another liver enzyme known as CYP2D6 that also breaks down aripiprazole and can increase the amount of aripiprazole in the body. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during quinidine therapy. Other medicines that block CYP2D6 include fluoxetine (Prozac) and paroxetine (Paxil).
- Alpha-1 receptor blockers [doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin)], used for control of blood pressure and prostatic enlargement, may increase the chance of hypotension (unusually low blood pressure).
List of brand names available for aripiprazole
Abilify, Abilify Maintena, and Aristrada are the brand names available for apriprazole in the US.
Is this drug safe to take if I'm pregnant or breastfeeding my baby?
- Aripiprazole has not been adequately studied during pregnancy. Neonates exposed to antipsychotic drugs in the third trimester may experience withdrawal symptoms and other side effects. Your doctor or other healthcare provider may choose to use this medication if he or she feels that its benefits outweigh this potential concern.
- It is not known if this medicine is excreted in breast milk; however, since most medicines are excreted in breast milk, doctors and other health care professionals recommend that women should not breastfeed their infant/baby while taking this drug.
What else should I know about this drug?
- Preparations of this medicine include:
- Tablets in doses of 2, 5 10, 15, 20, and 30 mg.
- Disintegrating tablets in doses of 10 and 15 mg.
- Oral solution dose of 1 mg/mL
- Injection solution dosages of 9.75 mg/1.3 ml (7.5 mg/ml)
- Extended Release Injection, Abilify Maintana, in doses of 300 or 400 mg/vial
- Extended Release Prefilled Syringe, Aristrada), in doses of 441, 662, and 882 mg.
- Tablets, oral solution, and injection should be stored at room temperature, 15 C to 30 C (59 F to 86 F).
- The FDA approved aripiprazole in November 2002.
Summary
Aripiprazole (Abilify, Abilify Maintena, Aristrada) is an antipsychotic medication used to treat psychoses such as:
- Schizophrgenia
- Bipolar mania and mixed manic/depressive episodes
- Major depressive disorder in adults
- Irritability associated with autistic disorder
- Tourette's disorder
- Agitation associated with schizophrenia or bipolar mania
- Sleepiness
- Rash
- Nausea
- Vomiting
- Tremors
- Weight gain
- Runny nose
Drug interactions, warnings and precautions, and pregnancy and breastfeeding safety information should be reviewed prior to taking any medication.
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