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Overview

Aripiprazole (Abilify®) belongs to a group of medications called “atypical antipsychotics” or “third-generation antipsychotics”.

What is aripiprazole used for?

• Schizophrenia and other thought disorders in patients under the age of 15
• Bipolar disorder in patients under the age of 13
• Irritability associated with autism
• Tic disorders like Tourette syndrome
• Disruptive behaviour disorders (including aggression)
• In combination with an antidepressant for treatment of depression

Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor.

How does aripiprazole work?

Like other atypical antipsychotics, aripiprazole affects the levels of certain chemicals in the brain called dopamine and serotonin. This has been shown to help people who have disorders like schizophrenia and bipolar disorder with their symptoms.  The exact way that antipsychotics improve the symptoms of schizophrenia and bipolar disorder is not fully known.

Aripiprazole in children and adolescents

Current evidence supports the use of aripiprazole in children and adolescents. Aripiprazole has been shown in a study to be better than placebo (an inactive pill that looks like the medication) in treating bipolar disorder and schizophrenia. Aripiprazole is also approved for the treatment of these disorders in children and adolescents in the United States.  Aripiprazole has been shown to be better than a placebo for treating irritability associated with autism.

Less information is available regarding the use of aripiprazole for treating aggression, tic disorders and Tourette syndrome. However, the available evidence is supportive.

Aripiprazole has been approved by Health Canada for treatment of schizophrenia and other thought disorders in adolescents 15 years of age or older and for treatment of bipolar disorder in adolescents 13 years of age and older. Like many medications used to treat childhood disorders, aripiprazole has not been approved by Health Canada for other uses in children and adolescents. When the potential benefits (e.g., reducing your symptoms) of using aripiprazole outweigh the potential risks (e.g., the side effects), many doctors may prescribe it “off-label” to treat several conditions.

How should aripiprazole be taken?

Aripiprazole is available as a tablet that is usually taken once daily with or without food. If you find that taking this medication causes stomach discomfort, try taking it with food. This medication should be taken at the same time each day as directed by your doctor. Try to connect taking it with something you do each day (like eating breakfast, or brushing your teeth) so you don’t forget.

Usually, your doctor will start with a low dose of aripiprazole that is best suited to your age and weight. This dose will then be slowly increased over a few weeks based on how you respond to it. You and your doctor can then discuss the best dosage to stay on based on how you tolerate this medication (how well it helps decrease your symptoms and how you are doing with side effects). Try to avoid alcohol while taking aripiprazole.

When will aripiprazole start working?

This depends on what you are using it for. Some improvements may be seen in as little as 1 to 2 weeks. However, it can sometimes take up to 6 weeks to see the full benefits of the medication. When aripiprazole is working well, you may notice that your thoughts are clearer and more organized. Agitation may be decreased and hearing voices or seeing things no one else sees (hallucinations) may stop completely or happen much less. Your mood may be more settled and you may see a reduction of intense fears and worries. It is important that you continue taking aripiprazole regularly even if you are feeling well, as it can prevent symptoms from returning. If you are taking this medication to help with symptoms of mood disturbance, you may notice some changes in the first 1 to 2 weeks.

Medications like aripiprazole do not work for everyone. If you are not feeling better within 6 weeks, your doctor may recommend switching you to a different medication.

How long do I have to take aripiprazole?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Most people will need to take aripiprazole for several months. This allows time for your symptoms to stabilize and for you to regain your functioning. Your doctor will discuss the benefits and risks of taking aripiprazole with you. At this time, you can also discuss how long you might need to take this medication.

Do not increase, decrease, or stop taking this medication without discussing it with your doctor.  If you stop taking aripiprazole suddenly, it is possible that your symptoms may return or you may have a bad reaction.

Is aripiprazole addictive?

No, aripiprazole is not addictive and you will not have “cravings” for this medication like you might with nicotine or street drugs. If you and your doctor decide it is best for you to stop taking aripiprazole, your doctor will explain how to safely come off this medication so you don’t feel negative effects as your body adjusts to being without it.

What are the side effects of aripiprazole and what should I do if I get them?

As with most medications, side effects may occur when taking aripiprazole. However, most side effects are mild and temporary. Sometimes the side effects may occur before any of the beneficial effects. It is also possible for some individuals to experience side effects that they feel are concerning or long-lasting. If this occurs, speak to your doctor about ways to manage them.

Below are some of the more common side effects of taking this medicine. In brackets are suggested ways to lessen these effects.

Common side effects

Side effects are usually more common when starting a medication or after a dose increase. If any of these side effects is troublesome for you, please discuss them with your doctor, nurse or pharmacist:

• Agitation (avoid caffeine from energy drinks, colas, tea and coffee)
• Blurred vision (usually disappears in 1-2 weeks; use bright lights or a magnifying glass when reading)
• Constipation (increase exercise, fluids, vegetables, fruits, and fiber)
• Dizziness or feeling lightheaded (try getting up slowly from a sitting or lying down position)
• Feeling tired, drowsiness, or difficulty falling asleep (speak with your doctor if these effects persist)
• Headache (try using a pain reliever like acetaminophen (plain Tylenol®))
• Muscle spasms or stiff muscles (there is a medication to relieve this, talk to your doctor)
• Nausea or stomach ache (try taking the medication with food)
• Weight gain (monitor your food intake, increase your exercise)

Uncommon side effects (e.g. those that occur in less than 5% of patients)

Contact your doctor IMMEDIATELY if you have any of these side effects:

• Fainting, feeling lightheaded or difficulties with balance
• Fast or irregular heart beat
• Feelings of restlessness
• Fever or excessive sweating
• Frequent urination accompanied by excessive thirst
• Rash
• Seizures
• Shaking, stiffness or difficulty moving, muscle spasm or stiffness in your throat or tongue
• Thoughts of hurting yourself, suicide, increased irritability/hostility or feeling worse
• Weakness or severe muscle pain

Aripiprazole is sometimes associated with a very rare side effect called “neuroleptic malignant syndrome”. The symptoms may include severe muscle stiffness, high fever, increased heart rate and blood pressure, irregular heartbeat (pulse) and sweating. Contact your doctor right away if this occurs.

On rare occasions, medications like aripiprazole have been associated with a side effect called “tardive dyskinesia”. This is a side effect that can sometimes become permanent in patients who take antipsychotic medications. It involves involuntary movements of some muscles in the body like the lips, tongue, toes, hands and neck. Stopping the antipsychotic at the first signs of it occurring or switching to another “atypical” antipsychotic can decrease the chances of having this side effect continue.

Tip: Aripiprazole can make some individuals feel drowsy, dizzy or slowed down. If you experience these temporary side effects, it is important to avoid operating heavy machinery or driving a car.

What precautions should my doctor and I be aware of when taking aripiprazole?

Tell your doctor or pharmacist if you:

• Have any allergies, or have experienced a reaction to a medication
• Are taking, or plan to start taking any other prescription or non-prescription medications (including herbal products).  Some medications may interact with aripiprazole. Your doctor may need to change the doses of your medications or monitor you carefully for side effects if you are taking medications that interact with aripiprazole.
• Have a history of heart disease, diabetes (or a family history of diabetes) or low blood pressure.
• Miss a period, are pregnant (or are planning to become pregnant) or are breast-feeding. Tell your doctor if you become pregnant while taking aripiprazole
• Are currently using alcohol or street drugs. These substances may interfere with how well aripiprazole works for you and/or make you feel drowsy.

Tip: When taking this medication, your body may have difficulty regulating your temperature. 

Make sure you drink lots of fluids and water to avoid becoming dehydrated.  You should avoid doing a lot of physical activities on hot days.

What special instructions should I follow while using aripiprazole?

• Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check how you are responding to aripiprazole, and to monitor for side effects.
• Try to keep a healthy and well-balanced diet and exercise regularly. Some individuals who take aripiprazole may gain weight due to an increase in appetite.
• Do not allow anyone else to use your medication.

Tip: Use the Antipsychotic Monitoring Form for Children and Adolescents to help measure your progress on this medication. Also see the document Atypical Antipsychotics & Metabolic Monitoring.

What should I do if I forget to take a dose of aripiprazole?

If you take aripiprazole regularly and you forget to take it, take the missed dose as soon as you remember. However, if it is almost time for your next dose (e.g. within 4 hours), skip the missed dose and continue with your regular dosing schedule.  Do NOT double your next dose.

What storage conditions are needed for aripiprazole?

• Keep this medication in the original container, stored at room temperature away from moisture and heat (e.g. not in the bathroom or kitchen) and protected from light.
• Keep this medication out of reach and sight of children.

About this document

Special thanks to the Kelty Centre for Mental Health for permission to adapt this document. The original document was developed by health professionals of BC Mental Health and Addiction Services, and reviewed by the staff of the Kelty Mental Health Centre. French translation provided courtesy of the Ontario Centre of Excellence for Child and Youth Mental Health and the Children's Hospital of Eastern Ontario (CHEO).

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Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.