Abilify

Abilify (aripiprazole) is an atypical antipsychotic approved by the FDA to treat various mental health conditions such as schizophrenia, bipolar I disorder, depression, autism-related irritability, and Tourette syndrome. It works by regulating dopamine and serotonin levels in the brain. Abilify is available in multiple strengths and is typically prescribed as a long-term treatment. Patients need to discuss their medical history and any medications or supplements they are taking with their healthcare provider to avoid interactions. Common side effects include nausea, dizziness, and sleepiness. In contrast, serious side effects may consist of an increased risk of death in older adults with dementia-related psychosis and suicidal thoughts in younger individuals.

Abilify (aripiprazole) is an atypical antipsychotic medication extensively prescribed to manage a spectrum of mental health disorders, including schizophrenia, manic and mixed episodes of bipolar I disorder, major depressive disorder (in combination with other antidepressants), irritability associated with autism, and Tourette syndrome. It functions primarily by balancing the neurotransmitters dopamine and serotonin in the brain, which helps to stabilize mood, behavior, and thought processes.

Abilify is available in tablet form with dosages ranging from 2 mg to 30 mg. The appropriate dosage varies based on the condition being treated and individual patient needs, with adjustments made over time based on therapeutic response and side effects. It can be taken with or without food, and it’s recommended to take it at the same time each day to maintain consistent blood levels. Patients should discuss their complete health history with their doctor before starting Abilify, especially if they have conditions like low blood pressure, heart problems, seizures, or diabetes or if they are pregnant or breastfeeding. It’s also crucial to inform healthcare providers about all other medications, supplements, and vitamins being taken to avoid potential interactions.

Common side effects of Abilify include nausea, dizziness, sleepiness, and headache. More serious risks involve neuroleptic malignant syndrome, tardive dyskinesia, severe allergic reactions, and metabolic changes. Abilify carries FDA-boxed warnings about an increased risk of death in elderly patients with dementia-related psychosis and the potential for suicidal thoughts and behaviors in children and young adults. Monitoring by healthcare professionals is essential to manage side effects and adjust treatment as needed.

Abilify is used to treat several psychiatric conditions:

• Schizophrenia (approved for adults and children aged 13 years and older)
• Bipolar I Disorder (used to manage manic and mixed episodes in adults and children aged 10 years and older)
• Major Depressive Disorder (MDD) (commonly known as depression, this approval is for use in adults and involves using Abilify alongside other medications)
• Irritability Associated with Autism (approved for children aged 6 years and older)
• Tourette Syndrome: Approved for children aged 6 years and older)

Dosage

This medication comes in the form of tablets and is available in the following strengths:

• Abilify 2 mg tablets
• Abilify 5 mg tablets
• Abilify 10 mg tablets
• Abilify 15 mg tablets
• Abilify 20 mg tablets
• Abilify 30 mg tablets

Recommended Dosage for Different Patients

Dosage for Major Depressive Disorder (MDD)

It is important to note that Abilify is not used as a standalone treatment but is combined with other medications.

• Starting Dosage: Typically, the initial dosage of Abilify for treating MDD is between 2 mg and 5 mg taken once daily. Depending on the individual’s response to the treatment, the dosage may be gradually increased by up to 5 mg per week until a noticeable reduction in depression symptoms is achieved.
• Maintenance Dosage: Once the effective dose is determined, the maintenance dosage usually ranges from 2 mg to 15 mg per day. The maximum dosage of Abilify for MDD should not exceed 15 mg daily.

Dosage for Managing Manic & Mixed Episodes in Bipolar I Disorder

• Starting Dosage: The usual initial dosage for adults is 15 mg of Abilify taken once daily. If you are also taking valproate or lithium (medications commonly used for bipolar disorder), the recommended starting dosage may vary between 10 mg and 15 mg once daily, depending on your doctor’s advice.
• Maintenance Dosage: The standard maintenance dosage is 15 mg once daily. In some instances, the dosage may be increased up to 30 mg per day, which is the maximum allowable daily dosage for this condition.

Dosage for Treating Schizophrenia in Adults

• Starting Dosage: The initial recommended dosage for treating schizophrenia with Abilify is usually between 10 mg and 15 mg, taken once daily. If symptoms persist after two weeks of treatment, your doctor may consider increasing the dosage.
• Maintenance Dosage: The ongoing daily dosage typically ranges from 10 mg to 30 mg. It’s important to note that the maximum daily dosage for schizophrenia should not exceed 30 mg.

Children’s dosage

Dosage for Treating Schizophrenia

Abilify is approved for treating schizophrenia in teenagers between the ages of 13 and 17.

• Starting Dosage: The initial dosage is typically 2 mg once daily. After two days of treatment, your child’s doctor may increase the dosage to 5 mg daily. Following another two days, the dosage may be further adjusted to 10 mg daily.
• Dosage Adjustments: Doses ranging from 10 mg to 30 mg daily have been studied and can be considered based on the individual needs of your child. The appropriate dosage will be determined by your child’s doctor, who will tailor the treatment to achieve the best results while monitoring for safety and effectiveness.

Dosage for Bipolar I Disorder

Abilify is approved for treating children and teenagers aged 10 to 17 who experience manic or mixed episodes associated with bipolar I disorder.

• Starting Dosage: The treatment typically begins with a dosage of 2 mg once daily. After two days, the doctor may increase the dose to 5 mg daily. Following an additional two days, the dosage can be further increased to 10 mg daily.
• Adjusting Dosage: If further adjustments are needed, the dosage may be increased by 5 mg each day, with a maximum limit of 30 mg daily. These adjustments continue until there is a noticeable improvement in the symptoms of bipolar I disorder.
• Co-administration with Lithium or Valproate: If your child is also taking lithium or valproate (other medications used for treating bipolar disorder), the dosages of Abilify remain consistent with those outlined above.

Dosage for Managing Autism-Related Irritability

Abilify is approved for the treatment of irritability associated with autism in children between the ages of 6 and 17.

• Starting Dosage: The initial dosage for this condition is 2 mg once daily. After at least one week of treatment, if well-tolerated, the dosage may be increased to 5 mg daily.
• Further Dosage Adjustments: Once your child has been on a daily dose of 5 mg for at least another week and if further adjustment is needed, the dosage can be increased to between 10 mg and 15 mg daily. It is essential to wait at least one week before making each dosage adjustment to monitor the effects and ensure tolerability.
• Maintenance Dosage: This dose provides the best balance of effectiveness and minimal side effects and typically ranges from 5 mg to 15 mg daily.

Dosage for Treating Tourette Syndrome

Abilify is approved for managing Tourette syndrome in children from 6 to 18 years of age. The initial dosage is determined based on the child’s body weight.

• For Children Under 50 kg (approximately 110 pounds):
• • • Starting Dosage: 2 mg daily.
    • Adjustment After 2 Days: Increase to 5 mg daily.
    • Further Adjustment After 1 Week: If symptoms persist, the dosage may be increased to 10 mg daily.
• For Children 50 kg (approximately 110 pounds) and Over:
• • Starting Dosage: 2 mg daily.
  • Adjustment After 2 Days: Increase to 5 mg daily.
  • Further Adjustment After 5 Days: Increase to 10 mg daily.
  • Maximum Dosage: If symptoms continue, the dosage can be increased up to a maximum of 20 mg daily.

[Note: These recommendations may vary from person to person. Discuss them with your doctor, and they’ll customize your dosage accordingly.]

• The manufacturer does not specify an ideal time of day to take Abilify. However, it is recommended that you take it at the same time each day to maintain a consistent level of the medication in your body, which helps ensure its effectiveness.
• Abilify can be taken with or without food, according to your preference.
• The oral tablets should be swallowed whole and not crushed, split, or chewed.
• Abilify is generally prescribed as a long-term treatment. If it is working well and you are tolerating it without significant side effects, your doctor may recommend that you continue taking it for an extended period.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

Abilify is known generically as aripiprazole, and it is categorized as an atypical antipsychotic drug. It operates by regulating the levels of dopamine and serotonin in the brain, which are hormones that significantly influence mood, behavior, and thoughts. Atypical antipsychotics, including Abilify, are commonly used to manage various mental health conditions. This medication may have other uses; for more information or if you have questions, it is advisable to consult your healthcare provider or pharmacist.

Common side effects of Abilify in children may include:

• Nausea or vomiting
• Blurry vision
• Dizziness
• Feeling sleepy
• Fatigue (lack of energy)
• Muscle stiffness
• Headache
• Tremor (shaking)
• Stuffy nose
• Feeling restless
• Weight gain
• Fever
• Insomnia (trouble falling or staying asleep)
• Drooling or having more saliva than usual
• Changes in appetite

Mild side effects of Abilify may include:

• Headache
• Feeling sleepy or having insomnia (trouble staying asleep or falling asleep)
• Blurry vision or dizziness
• Memory loss
• Restlessness or feeling like you need to move
• Hair loss
• Nausea, constipation, or vomiting
• Sexual side effects, such as sexual urges or changes in libido
• Anxiety
• Rash
• Upper respiratory infection, such as a cold
• Mild allergic reaction

Serious side effects of Abilify may include:

• Neuroleptic malignant syndrome (reaction to antipsychotic medications) and its signs may include:
  • Rigid muscles
  • Fast heart rate
  • High fever
• Feeling the urge to do excessively do certain or unusual things and its signs may include:
  • Compulsive shopping
  • Binge eating
  • Sexual urges
  • Gambling
• Changes in the metabolism, such as high cholesterol or diabetes, and its signs may include:
  • Being confused
  • Feeling very thirsty or hungry
  • Gaining weight
• Reduced blood pressure when you’re sitting or standing up, which may even lead to falls and its signs include:
  • Fainting
  • Dizziness
• Impaired ability to move or think, its signs may include:
  • Feeling tired
  • Trouble thinking clearly
  • Decreased motor skills
• Decreased levels of neutrophils or white blood cells and its signs may include:
  • Infections that don’t go away
  • Fever
• Problems with the control and temperature of your body, its signs may include:
  • Redness
  • Sweating
• Stroke in older adults with psychosis (related to dementia) and its signs may include:
  • Feeling confused
  • Numbness or weakness on one side of your body
  • Trouble walking
• Extrapyramidal disorder (a disorder of movement caused by specific drugs), its signs may include:
  • Anxiety
  • Tremors
  • Trouble speaking
• Difficulty swallowing, its signs may include:
  • Feeling like food is stuck in your throat
  • Pain when swallowing
  • Heartburn
• Increased risk of death in some older adults
• Movement disorders like tardive dyskinesia (TD) or tremors
• Severe allergic reaction
• Suicidal behaviors & thoughts in younger adults

[Note: This list may not cover all possible side effects. Always consult with your healthcare provider for medical advice about side effects.]

Before starting Abilify, it’s crucial to discuss your health history with your doctor. Certain medical conditions and factors may make Abilify less suitable or riskier for you.

• Low Blood Pressure: Abilify can cause low blood pressure, particularly when you stand up from a sitting or lying position. This drop in blood pressure may lead to dizziness or fainting. If you have pre-existing low blood pressure or are on medication for blood pressure, you might be more susceptible to this side effect. Your doctor will likely monitor your blood pressure regularly while you are on Abilify.
• Risk of Dehydration and Overheating: Antipsychotic medications, including Abilify, can affect your body’s ability to regulate its core temperature. This can put you at a higher risk of overheating or heat stroke, especially in hot weather or during intense physical activity. Additionally, taking Abilify can increase your risk of becoming dehydrated, which not only contributes to overheating but can also exacerbate low blood pressure. It’s essential to stay well-hydrated by drinking ample fluids while you are taking this medication.
• Heart Issues and Strokes: Abilify can affect blood pressure, causing it to be either too low or too high. If you have existing heart conditions or have previously experienced a stroke, fluctuations in blood pressure could, although rarely, trigger a heart attack or another stroke. It’s important to monitor your cardiovascular health closely while taking Abilify.
• Diabetes Management: Antipsychotic medications like Abilify can sometimes lead to increased blood sugar levels. If you have diabetes, this effect could make managing your blood sugar more challenging. Your doctor may need to test your blood sugar levels more frequently and adjust your diabetes medications as necessary to maintain proper control. For individuals with obesity or prediabetes, frequent monitoring of blood sugar levels is also advisable while taking Abilify. If your blood sugar rises too high, your healthcare provider might prescribe additional medications to help lower it. These precautions are vital to ensure that your treatment does not adversely affect your overall health.
• High Cholesterol and Triglycerides: Antipsychotic medications like Abilify can lead to elevated levels of cholesterol and triglycerides, which are types of fats in the blood. If you already struggle with high cholesterol or triglycerides, taking Abilify might worsen your condition. To manage this risk, your doctor may regularly monitor your cholesterol and triglyceride levels while you are on Abilify. If necessary, they might prescribe medications to help lower these levels. Additionally, if you are already taking medication for cholesterol or triglycerides, your doctor may need to adjust the dosages.
• Low White Blood Cell Count: Abilify has the potential to lower white blood cell counts, increasing the risk of infections. If you have a history of low white blood cell counts or currently have a low count, you might be at an increased risk when taking Abilify. Your doctor will consider your health history to decide if Abilify is suitable for you. If prescribed, they will likely monitor your white blood cell count throughout your treatment to ensure your immune system remains robust enough to fight infections.
• Seizures: Abilify has been known to cause seizures in some cases. If you have a history of seizures, you may be at an increased risk of experiencing seizures while taking Abilify. It’s important to discuss your medical history with your doctor to determine whether Abilify is a suitable treatment option for you.
• CYP2D6 Poor Metabolizers: CYP2D6 is an enzyme in your liver that plays a critical role in the breakdown of many drugs, including Abilify. Some individuals have a genetic variation that makes them poor metabolizers of drugs processed by CYP2D6, which can lead to higher concentrations of these drugs in the body and increase the risk of adverse effects. If you are known to be a CYP2D6 poor metabolizer, your doctor may prescribe a lower than usual dose of Abilify to prevent drug accumulation and reduce the risk of side effects.

Boxed Warning

FDA Boxed Warnings for Abilify: Boxed warnings are the most stringent warnings issued by the Food and Drug Administration (FDA). They are used to inform both doctors and patients about potentially severe risks associated with a medication.

• Increased Risk of Death in Older Adults with Dementia-Related Psychosis: Abilify carries a risk of increased mortality in older adults with psychosis related to dementia. Psychosis may involve losing touch with reality, including hallucinations or delusions. Due to this significant risk, Abilify is not recommended for use in this population. If you are experiencing symptoms of dementia-related psychosis while taking Abilify, it is crucial to consult with your doctor immediately. Your doctor can assess your condition and suggest alternative treatment options.
• Increased Risk of Suicidal Thoughts and Behaviors in Younger Individuals: Abilify may heighten the risk of suicidal thoughts and behaviors in children and adults up to 24 years of age. It is vital that those taking Abilify are closely monitored by their healthcare provider for signs of worsening depression and the emergence of suicidal thoughts or actions. It is advisable for family members to observe any mood changes in individuals taking Abilify. Early detection of mood changes can help in managing potential risks effectively. If you experience new or worsening depression, contact your doctor promptly. However, if you have thoughts of self-harm, it is critical to call 911 or your local emergency services immediately.

• Pregnancy: The safety of Abilify during pregnancy has not been definitively established. If you are pregnant or planning to become pregnant, it is crucial to discuss the potential risks and benefits of taking Abilify with your doctor. This discussion will help you make an informed decision about whether to use this medication during your pregnancy.
• Breastfeeding: Abilify can pass into breast milk and may affect a nursing infant. If you are breastfeeding or planning to breastfeed, consult with your doctor. They will be able to advise you on alternative feeding options for your child and help determine whether continuing Abilify is appropriate for your specific situation.
• Allergic Reaction: If you have previously experienced an allergic reaction to Abilify or any of its ingredients, your doctor will likely advise against using this medication. Allergic reactions can include symptoms such as rash, itching, swelling, severe dizziness, or trouble breathing. If you suspect you are allergic to any component of Abilify, inform your healthcare provider immediately.
• Older Adults: Abilify is generally not prescribed to older adults who have psychosis related to dementia. This is because antipsychotic medications, including Abilify, have been linked to an increased risk of death in older individuals with dementia-related psychosis. Furthermore, older adults may be more susceptible to experiencing low blood pressure as a side effect of antipsychotics like Abilify. Low blood pressure can lead to dizziness and increase the risk of falls. If you are an older adult or caring for one, discuss these risks with your doctor to get more specific information and guidance.
• Young Adults and Adolescents: Abilify is used to treat various mental health conditions, such as depression, which itself can sometimes increase the risk of suicidal thoughts and behaviors, particularly in individuals under the age of 25. Research indicates that antidepressants can heighten the risk of these thoughts and behaviors in children and young adults up to age 25, especially during the initial stages of treatment or following a dosage adjustment. It’s important to note that while Abilify can be prescribed in combination with antidepressants for treating depression, it is not approved for treating depression in individuals younger than 18.

• If you forget to take a dose of Abilify and remember within a few hours of your usual time, take the missed dose as soon as possible. If a whole day has passed, simply skip the missed dose and continue with your regular schedule by taking the next dose at its normal time.
• Do not double up doses to compensate for the one you missed.
• If you miss two or more doses consecutively, it’s important to contact your doctor for guidance on how to proceed safely.
• If you forget or are unable to attend your appointment for a long-acting injection of Abilify, contact your doctor or nurse promptly to reschedule as soon as possible.
• If you find you’re frequently forgetting to take your medication, setting an alarm as a reminder can be helpful. Additionally, you can speak to your pharmacist for more strategies to assist in remembering to take your medication regularly.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Do not exceed the dosage of Abilify prescribed by your doctor, as using more than recommended can lead to severe side effects. If too much medication is taken, the following symptoms may occur:

• Heart issues, including atrial fibrillation (an irregular heartbeat) and an increased heart rate
• Vomiting
• Blood pressure that is either too high or too low
• Loss of consciousness
• Breathing difficulties, which may slow down or stop entirely
• Abnormal results in blood tests that monitor liver and kidney function
• Sleepiness
• Aggression
• Tremors or convulsions

If you suspect an overdose of Abilify, it is important to seek immediate medical assistance. Contact your doctor promptly or call America’s Poison Centers for guidance on what to do next.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

• Keep Abilify in a closed container at room temperature, ensuring it is away from sources of heat, moisture, and direct sunlight to maintain its effectiveness. Be sure to prevent the medication from freezing.
• Always store the medication out of reach of children to prevent accidental ingestion, which could be harmful.
• Do not hold onto medicine that is outdated or no longer required for your treatment. For safe disposal methods of unused medication, consult your healthcare provider or pharmacist. They can provide you with the best practices for disposing of medicines responsibly.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Interactions with Alcohol

While it may be technically safe to consume alcohol during treatment with Abilify, it’s important to be cautious. Alcohol can exacerbate some side effects of Abilify, such as dizziness, nausea, and sleepiness. For detailed information on Abilify’s side effects, refer to relevant medical articles or resources. If you consume alcohol, discuss with your doctor to determine a safe amount you can drink while on Abilify.

Interactions with Other Drugs

Before you begin taking Abilify, it is crucial to inform your doctor and pharmacist about all other medications you are using, whether they are prescription, over-the-counter, or herbal products. Providing this information is essential for preventing potential drug interactions. If you have any concerns about how other drugs might interact with Abilify, do not hesitate to discuss these with your healthcare provider or pharmacist. Below is a list of drugs that may interact with Abilify. Keep in mind that this chart is not exhaustive and does not cover all possible drug interactions with Abilify.

• Benzodiazepines: These medications may increase the risk of side effects from Abilify. Examples include Lorazepam (Loreev XR, Ativan), Alprazolam (Xanax XR, Xanax), Diazepam (Valium)
• Blood Pressure Medications: These drugs can enhance the effects of blood pressure drugs, potentially causing lightheadedness or fainting when standing up from a sitting or lying position.
  • Types: Alpha-blockers, Beta-blockers, Angiotensin II Receptor Blockers, Calcium Channel Blockers, Angiotensin-Converting Enzyme Inhibitors
  • Examples: Lisinopril (Zestril), Metoprolol (Toprol-XL, Lopressor), Losartan (Cozaar), Prazosin (Minipress), Amlodipine (Norvasc, Norliqva)
• Certain Antidepressants: This may raise the risk of side effects from Abilify. Examples include Paroxetine (Paxil), Fluoxetine (Prozac), Duloxetine (Cymbalta), Trazodone, Bupropion (Wellbutrin XL, Wellbutrin SR), Venlafaxine (Effexor XR), Sertraline (Zoloft)
• Certain Antibiotics: These drugs may increase the risk of side effects from Abilify or make Abilify less effective than usual. Examples include Rifampin (Rimactane, Rifadin), Clarithromycin.
• Certain Antifungal Drugs: These drugs can increase the risk of side effects from Abilify. Examples include Itraconazole (Tolsura, Sporanox), Ketoconazole
• Quetiapine: This drug can raise the risk of side effects from Abilify. Examples include Seroquel XR, Seroquel
• Carbamazepine: These medications can make Abilify less effective than usual. Examples include Epitol, Carbatrol, and Tegretol.
• Quinidine: These drugs can increase the risk of side effects from Abilify.

Other Interactions

• Interaction with Supplements: Before starting Abilify, discuss with your doctor and pharmacist all supplements, herbs, and vitamins you are taking to avoid potential interactions.
• Interaction with St. John’s Wort: Abilify may interact with the herbal supplement St. John’s Wort, commonly used to treat depression. This herb can make Abilify less effective by increasing the activity of an enzyme that removes Abilify from your body. If you are taking St. John’s wort, inform your doctor, as they may need to adjust your Abilify dosage to maintain its effectiveness.
• Interaction with Vitamins: Currently, there are no known interactions between Abilify and vitamins. However, since new interactions could be identified in the future, it’s important to consult your healthcare provider before taking any vitamins while on Abilify.
• Interaction with Food Interactions: Grapefruit and grapefruit products may interact with Abilify, leading to increased levels of the drug in the body and potentially heightening side effects. It’s advisable to avoid grapefruit products while undergoing treatment with Abilify. There are no known interactions with other foods, but if you have concerns about specific foods, discuss them with your doctor.
• Interaction with Vaccines: There are no reported interactions between Abilify and vaccines. If you have concerns about receiving vaccines while on Abilify, consult your doctor for advice.
• Interaction with Lab Tests: Abilify is not known to interact with laboratory tests. If you have questions about undergoing lab tests while taking Abilify, speak with your healthcare provider.

[Note: This isn’t a complete list, and there could be other drugs that interact with Abilify. Make sure to tell your doctor about any prescription, over-the-counter, or herbal products you’re taking.]

• Clozaril (clozapine)
• Geodon (ziprasidone)
• Haldol (haloperidol)
• Invega (paliperidone)
• Latuda (lurasidone)
• Loxitane (loxapine)
• Mellaril (thioridazine)
• Moban (molindone)
• Navane (thiothixene)
• Prolixin (fluphenazine)
• Rexulti (brexpiprazole)
• Risperdal (risperidone)
• Saphris (asenapine)
• Seroquel (quetiapine)
• Stelazine (trifluoperazine)
• Thorazine (chlorpromazine)
• Trilafon (perphenazine)
• Vraylar (cariprazine)
• Zyprexa (olanzapine)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

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