Aripiprazole
Aripiprazole, sold under the brand name Abilify, Aripiprex, Ariply among others, is an atypical antipsychotic primarily used in the treatment of schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder; other uses include as an add-on treatment for major depressive disorder and tic disorders. Aripiprazole is taken by mouth or via injection into a muscle.
Common side effects include restlessness, insomnia, transient weight gain, nausea, vomiting, constipation, dizziness, and mild sedation. Serious side effects may include neuroleptic malignant syndrome, tardive dyskinesia, and anaphylaxis. It is not recommended for older people with dementia-related psychosis due to an increased risk of death. In pregnancy, there is evidence of possible harm to the fetus. It is not recommended in women who are breastfeeding. It has not been very well studied in people younger than 18.
Aripiprazole was approved for medical use in the United States in 2002. It is available as a generic medication. In 2023, it was the 95th most commonly prescribed medication in the U.S., with more than 7million prescriptions. It is on the World Health Organization's List of Essential Medicines.
Medical uses
Aripiprazole is primarily used for the treatment of schizophrenia or bipolar disorder.Schizophrenia
The 2016 National Institute for Health and Care Excellence guidance for treating psychosis and schizophrenia in children and young people recommended aripiprazole as a second-line treatment after risperidone for people between 15 and 17 who are having an acute exacerbation or recurrence of psychosis or schizophrenia. A 2014 NICE review of the depot formulation of the drug found that it may have a role in treatment as an alternative to other depot formulations of second-generation antipsychotics for people who have trouble taking medication as directed or who prefer it.A 2014 Cochrane review comparing aripiprazole and other atypical antipsychotics found it difficult to determine differences as data quality is poor. A 2011 Cochrane review comparing aripiprazole with placebo concluded that high dropout rates in clinical trials, and a lack of outcome data regarding general functioning, behavior, mortality, economic outcomes, or cognitive functioning make it difficult to definitively conclude that aripiprazole is useful in preventing relapse. This review found only low-quality evidence of effectiveness in treating schizophrenia.
A 2013 review placed aripiprazole in the middle range of 15 antipsychotics for effectiveness, approximately as effective as haloperidol and quetiapine and slightly more effective than ziprasidone, chlorpromazine, or asenapine, with better tolerability compared to the other antipsychotic drugs. The authors concluded that for acute psychotic episodes, aripiprazole results in benefits in some aspects of the condition. It lowers prolactin levels. In cases of hyperprolactinaemia caused by other antipsychotics, the addition of or switch to aripiprazole is used to lower prolactin levels.
Aripiprazole is recommended as the initial treatment for schizophrenia according to the INTEGRATE consensus international guidelines.
In 2013 the World Federation of Societies for Biological Psychiatry recommended aripiprazole for treatment of acute exacerbations of schizophrenia as a Grade 1 recommendation and evidence level A.
The British Association for Psychopharmacology similarly recommends that all persons presenting with psychosis receive treatment with an antipsychotic and that such treatment should continue for at least 1–2 years, as "There is no doubt that antipsychotic discontinuation is strongly associated with relapse during this period". The guideline further notes that "Established schizophrenia requires continued maintenance with doses of antipsychotic medication within the recommended range ".
The British Association for Psychopharmacology and the World Federation of Societies for Biological Psychiatry suggest there is little difference in effectiveness between antipsychotics in preventing relapse and recommend that the specific antipsychotic be chosen based on each person's preference and side effect profile. The latter group recommends switching to aripiprazole when excessive weight gain is encountered during treatment with other antipsychotics.
Bipolar disorder
Aripiprazole is effective for the treatment of acute manic episodes of bipolar disorder in adults, children, and adolescents. Used as maintenance therapy, it is useful for the prevention of manic episodes but is not for bipolar depression. Thus, it is often used in combination with an additional mood stabilizer; however, co-administration with a mood stabilizer increases the risk of extrapyramidal side effects. In September 2014, aripiprazole had a UK marketing authorization for up to 12 weeks of treatment for moderate to severe manic episodes in bipolar I disorder in young people aged 13 and older. Aripiprazole in doses of 2.5 mg can cause mania in those with bipolar disorder.Depression
Aripiprazole is an effective add-on treatment for major depressive disorder but increases the risk of side effects such as weight gain and movement disorders. The overall benefit is small to moderate and its use appears to improve neither quality of life nor functioning. Aripiprazole may interact with some antidepressants, especially selective serotonin reuptake inhibitors that are metabolized by CYP2D6. There are known interactions with fluoxetine and paroxetine and lesser interactions with sertraline, escitalopram, citalopram and fluvoxamine. CYP2D6 inhibitors increase aripiprazole concentrations by 2–3 times. When strong CYP2D6 SSRIs are co-administered, the Food and Drug Administration recommends dose monitoring, although it is not clear the SSRI dose should be lowered.Autism
Short-term data shows reduced irritability, hyperactivity, inappropriate speech, and stereotypy, but no change in lethargic behaviors. Adverse effects include weight gain, sleepiness, drooling, and tremors. It is suggested that children and adolescents need to be monitored regularly while taking this medication to evaluate if this treatment option is still effective after long-term use and note if side effects are worsening. Further studies are needed to understand if this drug is helpful for children after long-term use.Tic disorders
Aripiprazole is approved for the treatment of Tourette syndrome and other tic disorders. There is evidence supporting that it is effective, safe, and well-tolerated for this use per systematic reviews and meta-analyses.Obsessive-compulsive disorder
A 2014 systematic review and meta-analysis concluded that add-on therapy with low-dose aripiprazole is an effective treatment for obsessive-compulsive disorder that does not improve with selective serotonin reuptake inhibitors alone. The conclusion was based on the results of two relatively small, short-term trials, each of which demonstrated improvements in symptoms. However, aripiprazole is cautiously recommended by a 2017 review on antipsychotics for OCD. Aripiprazole is not currently approved for the treatment of OCD and is instead used off-label for this indication. Depending on the dose, aripiprazole can increase impulse control issues in a small fraction of people. The FDA Drug Safety Communication warned about this side effect.Available forms
Aripiprazole is available in the form of oral tablets, oral films, oral disintegrating tablets, oral solution, digital pills with sensors, and as a short-acting injectable for intramuscular administration. It is also available as a long-acting injectable, aripiprazole lauroxil, a lipophilic ester prodrug of aripiprazole designed to be given once per month, and as a once every two months long-acting injectable, under the brand name Abilify Asimtufii.Contraindications
s to aripiprazole include known hypersensitivity to aripiprazole, among others.Adverse effects
In elderly people with dementia-related psychosis who are treated with antipsychotics, there is an increased risk of death. In children, adolescents, and young adults treated with antidepressants there is an increased risk of suicidal thoughts or behavior.In adults, side effects with greater than 10% incidence include weight gain, mania, headache, akathisia, insomnia, delirium, and gastrointestinal effects like nausea, constipation, and lightheadedness. Side effects in children are similar, and include sleepiness, increased appetite, and stuffy nose. A strong desire to gamble, binge eat, shop, and engage in sexual activity also rarely occur. These urges can be uncontrollable.
Uncontrolled movement such as restlessness, tremors, and muscle rigidity may occur.
Discontinuation
The British National Formulary recommends gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a feeling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.There is tentative evidence that discontinuation of antipsychotics can result in psychosis as a part of a withdrawal syndrome. It may also result in reoccurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped.