Abilify® (aripiprazole)
Brand
name:
Abilify®
-
Tablets:
2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
-
Orally
disintegrating tablets: 10 mg, 15 mg
-
Liquid
suspension: 1 mg/mL
-
Injection
(immediate release): 9.75 mg/1.3mL
Generic
name: aripiprazole (ay
ri PIP ray zole)
Medication
class: Second generation antipsychotic (SGA), atypical antipsychotic
All FDA black box
warnings are at the end of this fact sheet. Please review
before taking this medication.
What
is Abilify® and
what does it treat?
Aripiprazole
is a medication that works in the brain to treat schizophrenia. It
is also known as a second generation antipsychotic (SGA) or atypical
antipsychotic. Aripiprazole
rebalances dopamine and serotonin to improve thinking, mood, and
behavior.
Symptoms
of schizophrenia include:
-
Hallucinations
- imagined voices or images that seem real
-
Delusions
- beliefs that are not true (e.g., other people are reading your
thoughts)
-
Disorganized
thinking or trouble organizing your thoughts and making sense
-
Little
desire to be around other people
-
Trouble
speaking clearly
-
Lack
of motivation
Aripiprazole
may help some or all of these symptoms.
Aripiprazole
is also FDA approved for the following indications:
-
Acute
treatment of manic or mixed episodes of bipolar disorder
-
Maintenance
(long-term) treatment of bipolar disorder (when used alone or with
lithium or valproate)
-
Adjunctive
treatment of major depressive disorder. This means aripiprazole is
used in addition to an antidepressant to help treat depression.
-
Irritability
associated with autistic disorders
-
Acute
treatment of agitation in schizophrenia and bipolar disorder
This
medication sheet will focus primarily on schizophrenia. You can find
more information about bipolar disorder, depression, and autism
spectrum disorders at http://www.nami.org/Template.cfm?Section=By_Illness.
What
is the most important information I should know about Abilify®?
Schizophrenia
requires long-term treatment. Do not stop taking aripiprazole, even
when you feel better.
Only
your healthcare provider can determine the length of aripiprazole
treatment that is right for you.
Missing
doses of aripiprazole may increase your risk for a relapse in your
symptoms.
Do
not stop taking aripiprazole or change your dose without talking to
with your healthcare provider first.
For
aripiprazole to work properly, it should be taken everyday as ordered
by your healthcare provider.
Are
there specific concerns about Abilify® and
pregnancy?
If
you are planning on becoming pregnant, notify your healthcare
provider to best manage your medications. People living with
schizophrenia who wish to become pregnant face important decisions.
This is a complex decision since untreated schizophrenia has risks to
the fetus, as well as the mother. It is important to discuss the
risks and benefits of treatment with your doctor and caregivers.
Caution
is advised with breastfeeding since aripiprazole does pass into
breast milk.
What
should I discuss with my healthcare provider before taking Abilify®?
-
Symptoms
of your condition that bother you the most
-
If
you have thoughts of suicide or harming yourself
-
Medications
you have taken in the past for your condition, whether they were
effective or caused any adverse effects
-
If
you ever had muscle stiffness, shaking, tardive dyskinesia,
neuroleptic malignant syndrome, or weight gain caused by a
medication
-
If
you experience side effects from your medications, discuss them with
your provider. Some side effects may pass with time, but others may
require changes in the medication.
-
Any
psychiatric or medical problems you have, such as heart rhythm
problems, long QT syndrome, heart attacks, diabetes, high
cholesterol, or seizures
-
If
you have a family history of diabetes or heart disease
-
All
other medications you are currently taking (including over the
counter products, herbal and nutritional supplements) and any
medication allergies you have
-
Other
non-medication treatment you are receiving, such as talk therapy or
substance abuse treatment. Your provider can explain how these
different treatments work with the medication.
-
If
you are pregnant, plan to become pregnant, or are breast-feeding
-
If
you smoke, drink alcohol, or use illegal drugs
How
should I take Abilify®?
Aripiprazole
is usually taken 1 time per day with or without food.
Typically
patients begin at a low dose of medicine and the dose is increased
slowly over several weeks.
The
oral dose usually ranges from 2 mg to 30 mg. Only
your healthcare provider can determine the correct dose for you.
Aripiprazole
orally
disintegrating tablets must remain in their original packaging. Open
the package with clean dry hands before each dose. Do not try to put
tablets in a pillbox if you take the orally disintegrating tablets.
Aripiprazole
orally
disintegrating tablets will dissolve in your mouth within seconds and
can be swallowed with or without liquid.
Aripiprazole
suspension: Measure with a dosing spoon or oral syringe, which you
can get from your pharmacy.
Use
a calendar, pillbox, alarm clock, or cell phone alert to help you
remember to take your medication. You may also ask a family
member a friend to remind you or check in with you to be sure you are
taking your medication.
What
happens if I miss a dose of Abilify®?
If
you miss a dose of aripiprazole,
take it as soon as you remember, unless it is closer to the time of
your next dose. Discuss this with your healthcare provider. Do not
double your next dose or take more than what is prescribed.
What
should I avoid while taking Abilify®?
Avoid
drinking alcohol or using illegal drugs while you are taking
aripiprazole. They may decrease the benefits (e.g. worsen your
confusion) and increase adverse effects (e.g. sedation) of the
medication.
What
happens if I overdose with Abilify®?
If
an overdose occurs call your doctor or 911. You may need urgent
medical care. You may also contact the poison control center at
1-800-222-1222.
A
specific treatment to reverse the effects of aripiprazole does not
exist.
What
are possible side effects of Abilify®?
Common
Side Effects
Constipation,
nausea, vomiting, headache, insomnia, tremor, blurred vision,
anxiety, fatigue
Feeling
drowsy, dizzy or restless
Rare
Side Effects
Rash,
increased appetite, dry mouth, muscle aches, seizure, agitation
Aripiprazole
may increase the blood levels of a hormone called prolactin. Side
effects of increased prolactin levels include females losing their
period, production of breast milk and males losing their sex drive or
possibly experiencing erectile problems. Long term (months or years)
of elevated prolactin can lead to osteoporosis or increased risk of
bone fractures.
Serious
Side Effects
Some
people may develop muscle related side effects while taking
aripiprazole. The technical terms for these are “extrapyramidal
effects” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS
include restlessness, tremor, and stiffness. TD symptoms include
slow or jerky movements that one cannot control, often starting in
the mouth with tongue rolling or chewing movements.
Second
generation antipsychotics (SGAs) increase the risk of weight gain,
high blood sugar, and high cholesterol. This is also known as
metabolic syndrome. Your healthcare provider may ask you for a blood
sample to check your cholesterol, blood sugar, and hemoglobin A1c (a
measure of blood sugar over time) while you take this medication.
SGAs
have been linked with higher risk of death, strokes, and transient
ischemic attacks (TIAs) in elderly people with behavior problems due
to dementia.
All
antipsychotics have been associated with the risk of sudden cardiac
death due to an arrhythmia (irregular heart beat). To minimize this
risk, antipsychotic medications should be used in the smallest
effective dose when the benefits outweigh the risks. Your doctor may
order an EKG to monitor for irregular heart beat.
Neuroleptic
malignant syndrome is a rare, life threatening adverse effect of
antipsychotics which occurs in <1% of patients. Symptoms include
confusion, fever, extreme muscle stiffness, and sweating. If any of
these symptoms occur, contact your healthcare provider immediately.
Are
there any risks of taking Abilify® for long periods of time?
Tardive
dyskinesia (TD) is a side effect that develops with prolonged use of
antipsychotics. Medications such as aripiprazole have been shown to
have a lower risk of TD compared to older antipsychotics, such as
Haldol (haloperidol). If you develop symptoms of TD, such as grimacing,
sucking, and smacking of lips, or other movements that you cannot
control, contact your healthcare provider immediately. All patients
taking either first or second generation antipsychotics should have
an Abnormal Involuntary Movement Scale (AIMS) completed regularly by
their healthcare provider to monitor for TD.
Second
generation antipsychotics (SGAs) increase the risk of diabetes,
weight gain, high cholesterol, and high triglycerides. (See “Serious
Side Effects” section for monitoring recommendations.)
What
other medications may interact with Abilify®?
The
following medications may increase the levels and effects of aripiprazole:
-
The
antibiotic clarithromycin (Biaxin®)
-
Antidepressants,
such as fluoxetine
(Prozac®),
paroxetine (Paxil®),
and nefazodone
-
Antifungals,
such as fluconazole (Diflucan®),
ketoconazole
(Nizoral®),
and itraconazole
(Sporanox®)
-
The
antiarrhymia agent quinidine
-
HIV
medications, such as the protease inhibitors indinavir (Crixivan®),
ritonavir (Norvir®),
saquinavir (Fortovase®,
Invirase®),
and lopinavir/ritonavir (Kaletra®)
The
following medications may decrease the levels and effects of aripiprazole: carbamazepine
(Tegretol®)
and rifampin (Rifadin®)
How
long does it take for Abilify® to
work?
It
is very important to tell your doctor how you feel things are going
during the first few weeks after
you start taking aripiprazole. It will
probably take several weeks to see big enough changes in your
symptoms to decide if aripiprazole is the
right medication for you.
Antipsychotic
treatment is generally needed lifelong for persons with
schizophrenia. Your doctor can best discuss the duration of treatment
you need based on your symptoms and illness.
-
Hallucinations,
disorganized thinking, and delusions may improve in the first 1-2
weeks
-
Sometimes
these symptoms do not completely go away
-
Motivation
and desire to be around other people can take at least 1-2 weeks to
improve
-
Symptoms
continue to get better the longer you take aripiprazole
-
It
may take 2-3 months before you get the full benefit of aripiprazole
Provided
by
College
of Psychiatric and Neurologic Pharmacists
(January
2013)
Summary
of FDA Black Box Warnings
Increased
Mortality in Elderly Patients with Dementia Related Psychosis
-
Both
first generation (typical) and second generation (atypical)
antipsychotics are associated with an increased risk of mortality in
elderly patients when used for dementia related psychosis.
-
Although
there were multiple causes of death in studies, most deaths appeared
to be due to cardiovascular causes (e.g. sudden cardiac death) or
infection (e.g. pneumonia).
-
Antipsychotics
are not indicated for the treatment of dementia-related psychosis.
Suicidal
Thoughts or Actions in Children and Adults
Depression
and certain other psychiatric disorders are themselves associated
with increases in the risk of suicide.
-
Patients
with major depressive disorder (MDD), both adult and pediatric, may
experience worsening of their depression and/or the emergence of
suicidal ideation and behavior (suicidality) or unusual changes in
behavior, whether or not they are taking medications. This risk may
persist until significant remission occurs.
-
Patients,
their families, and caregivers should be alert to the emergence of
anxiety, restlessness, irritability, aggressiveness and insomnia.
If these symptoms emerge, they should be reported to the patient’s
prescriber or healthcare professional.
-
All
patients being treated with this medication for depression should
watch for and notify their healthcare provider for worsening
symptoms, suicidality and unusual changes in behavior, especially
during the first few months of treatment.
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