Abilify (aripiprazole) is an atypical antipsychotic medication indicated for the treatment of several psychiatric conditions, including schizophrenia, bipolar I disorder, and as an adjunctive treatment for major depressive disorder. It functions as a partial agonist at dopamine D₂ and serotonin 5-HT₁A receptors and as an antagonist at serotonin 5-HT₂A receptors, offering a unique mechanism of action that modulates neurotransmitter activity rather than completely blocking it. This pharmacological profile contributes to its efficacy in managing positive and negative symptoms while potentially minimizing certain side effects associated with first-generation antipsychotics. Approved by the FDA, Abilify is available in multiple formulations, including oral tablets, orally disintegrating tablets, oral solution, and extended-release injectable forms, allowing for tailored treatment approaches based on individual patient needs and clinical circumstances.

Features

• Active ingredient: aripiprazole
• Available formulations: tablets, orally disintegrating tablets, oral solution, and monthly extended-release injectable (Abilify Maintena)
• Mechanism: partial dopamine D₂ and serotonin 5-HT₁A agonist; serotonin 5-HT₂A antagonist
• FDA-approved for: schizophrenia, bipolar I disorder (monotherapy and adjunctive), adjunctive treatment of major depressive disorder, irritability associated with autistic disorder, and Tourette’s disorder
• Dosing flexibility: multiple strengths ranging from 2 mg to 30 mg for oral forms; 300 mg or 400 mg monthly injections

Benefits

• Effective reduction of positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., social withdrawal, apathy) in schizophrenia
• Stabilization of mood episodes in bipolar I disorder, including manic and mixed episodes
• Enhancement of antidepressant effect when used adjunctively in major depressive disorder
• Lower risk of extrapyramidal symptoms and hyperprolactinemia compared to typical antipsychotics
• Long-acting injectable form improves adherence and provides consistent plasma levels
• May cause less sedation and weight gain than some other atypical antipsychotics

Common use

Abilify is commonly prescribed for the management of schizophrenia in adults and adolescents aged 13 years and older. It is also widely used in the treatment of acute manic and mixed episodes associated with bipolar I disorder in adults and pediatric patients aged 10 years and older, both as monotherapy and as an adjunct to lithium or valproate. Additionally, it is indicated as an adjunctive therapy to antidepressants for major depressive disorder in adults. Off-label uses may include treatment of agitation in dementia, borderline personality disorder, and other conditions, though these are not FDA-approved and require careful clinical consideration.

Dosage and direction

Dosage must be individualized based on indication, patient response, and tolerability. For schizophrenia in adults, the recommended starting dose is 10–15 mg once daily, with a target range of 10–30 mg/day. For bipolar mania, initial dosing is 15 mg once daily, which may be increased to 30 mg/day if necessary. As an adjunct for major depressive disorder, the starting dose is 2–5 mg/day, with a maximum of 15 mg/day. Oral formulations should be taken with or without food. For the extended-release injectable (Abilify Maintena), the initial dose is 400 mg monthly, with adjustments based on response. Dosage in pediatric and geriatric populations or those with hepatic/renal impairment may require reduction.

Precautions

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; Abilify is not approved for this use. Patients should be monitored for suicidal ideation, especially at treatment initiation. Caution is advised in those with cardiovascular disease, cerebrovascular conditions, or seizures. Abilify may impair judgment, thinking, or motor skills; patients should avoid driving or operating machinery until they know how the medication affects them. Regular monitoring of weight, blood glucose, and lipid levels is recommended due to potential metabolic effects.

Contraindications

Abilify is contraindicated in patients with known hypersensitivity to aripiprazole or any component of the formulation. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole) or strong CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine) may require dose adjustments and is relatively contraindicated without careful supervision. It should not be used in patients with severe hepatic impairment.

Possible side effect

Common side effects may include:

• Akathisia
• Headache
• Anxiety
• Insomnia
• Nausea
• Vomiting
• Constipation
• Dizziness

Serious side effects requiring medical attention:

• Neuroleptic malignant syndrome (NMS)
• Tardive dyskinesia
• Metabolic changes (hyperglycemia, dyslipidemia, weight gain)
• Orthostatic hypotension
• Leukopenia, neutropenia, agranulocytosis
• Seizures
• Dysphagia

Drug interaction

Abilify is primarily metabolized by CYP3A4 and CYP2D6 enzymes. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole) or CYP2D6 inhibitors (e.g., fluoxetine, quinidine) may increase aripiprazole concentrations. Conversely, strong CYP3A4 inducers (e.g., carbamazepine) may decrease its levels. Caution is advised when combining with other central nervous system depressants, including alcohol, benzodiazepines, or opioids, due to additive sedative effects. Abilify may enhance the hypotensive effects of antihypertensive drugs.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is close to the time of the next dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose is not recommended. For the extended-release injectable, contact the healthcare provider for guidance if an injection is missed.

Overdose

Symptoms of overdose may include sedation, vomiting, aggression, confusion, tremors, and hypotension. In severe cases, respiratory depression, coma, or seizures may occur. There is no specific antidote; management involves supportive care and symptomatic treatment. Gastric lavage and administration of activated charcoal may be considered if ingestion was recent. Immediate medical attention is required.

Storage

Store at room temperature (15–30°C or 59–86°F). Keep the oral solution in the original bottle; do not freeze. Protect from light and moisture. Keep all medications out of reach of children and pets. Do not use beyond the expiration date.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

Clinical studies and meta-analyses have demonstrated the efficacy of Abilify in reducing symptoms of schizophrenia and bipolar disorder, with a generally favorable tolerability profile compared to older antipsychotics. Many clinicians appreciate its partial agonist activity, which may offer a balanced effect on dopamine pathways. Patient experiences vary; some report significant improvement in symptoms and quality of life, while others note side effects such as akathisia or weight changes. Long-acting injectable formulations are often praised for improving adherence in maintenance therapy.