Abilify side effects and how to avoid them

Abilify side effects | Serious side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects | Resources

Abilify is a brand-name prescription drug approved by the FDA to treat schizophrenia, major depressive disorder (in combination with other medications), and, in children, Tourette’s disorder and irritability associated with autistic disorder. Abilify can also be used alone or in combination with lithium or valproate to treat manic episodes in people diagnosed with bipolar I disorder. Abilify is also available as Abilify MyCite (which contains a sensor), or Abilify Maintena (a monthly injection). 

The active ingredient in Abilify is aripiprazole, an atypical antipsychotic. The exact way Abilify works is not known, but it is thought to work by acting on dopamine and serotonin receptors in the brain. As with all antipsychotic drugs, Abilify has a number of side effects, warnings, restrictions, and drug interactions that may cause problems, so it helps to understand the downsides before starting this medicine.

RELATED: What is Abilify?

Common side effects of Abilify

The most common side effects of Abilify are:

• Headache
• Increased appetite/weight gain
• Drowsiness/sleepiness/sedation
• Agitation
• Insomnia
• High blood sugar
• Anxiety
• Stomach problems: nausea, constipation, vomiting
• Dizziness/lightheadedness
• Muscle and joint pain
• Sore throat
• Blurred vision
• Drooling/excess salivation
• Restlessness
• Compulsive behaviors
• High cholesterol
• Dry mouth
• Tremor
• Urine leakage
• Cough
• Changes in body temperature
• Fever and diarrhea (in children)

In addition to these side effects, approximately 12% of people taking Abilify MyCite in clinical trials experienced skin rashes where the MyCite patch was affixed.

Serious side effects of Abilify

The most serious side effects of Abilify include:

• Drug-induced movement problems (extrapyramidal effects) including akathisia, tardive dyskinesia, and dystonia
• Suicidal thoughts 
• Worsening depression
• Stroke/mini-stroke
• Fainting and falling
• Orthostatic hypotension (sudden drop in blood pressure when standing)
• Seizures
• Diabetes
• Severe difficulty swallowing
• Body temperature dysregulation
• High blood pressure (hypertension)
• Heart rate changes
• Intestinal obstruction
• Gallbladder stones
• Swelling of the pancreas (pancreatitis)
• Blood problems
• Low white blood cell counts
• Potassium imbalance
• Muscle damage
• Neuroleptic malignant syndrome (NMS)
• Severe allergic reactions

Patients who experience a serious reaction should notify their doctor or get emergency medical help right away. Severe allergic reactions require immediate emergency medical attention. Symptoms may include hives, difficulty breathing, or swelling around the face, lips, mouth, and tongue. 

How long do side effects last?

Aripiprazole has a half-life of 75 hours and its active metabolite, which works like aripiprazole, has a half-life of 94 hours. This means that many of the common side effects of aripiprazole such as headache, drowsiness, agitation, and anxiety, could take several days or even several weeks to resolve after the last dose is taken. Some side effects, such as headache and akathisia, may get better as the body adjusts to the drug.

The metabolic side effects of aripiprazole such as high blood sugar, high fats, high cholesterol, and weight gain may require treatment. 

Serious side effects such as extrapyramidal symptoms, severe allergic reactions, stroke, gallbladder stones, pancreatitis, heart rate irregularities, or low white blood cell counts may require emergency medical treatment. Some, like stroke or diabetes, may have lifelong complications. Extrapyramidal symptoms can clear up within a few weeks or they may persist for years and require a medication or dosage change.

Abilify contraindications & warnings

Abuse and dependence

Abilify is not a controlled substance, so healthcare professionals do not consider it an addictive drug. It also does not cause dependence, but may cause withdrawal when stopped abruptly. People taking Abilify should consult with a healthcare professional before stopping this medicine. 

Overdose

Taking too much Abilify is serious but probably not lethal. If too much Abilify is taken, seek emergency medical care or call a poison helpline. There are some symptoms that may signal an oral Abilify overdose. These include:

• Vomiting
• Somnolence
• Tremor
• Aggression
• Heart rate changes
• Blood pressure changes
• Confusion
• Lethargy
• Convulsions
• Loss of consciousness
• Coma

Restrictions

Not everyone can safely take Abilify. The hazards may be too great for some people, but others may be able to take Abilify with careful monitoring for adverse reactions. Restrictions include:

• Hypersensitivity: People with allergies to aripiprazole or any of the inactive ingredients of Abilify can never be given this medicine.
• Older adults with dementia-related psychosis cannot be given antipsychotic drugs like Abilify because of the increased risk of death.
• Children, adolescents, and young adults are at a higher risk for worsening depression and suicide. Patients of any age require careful monitoring by both healthcare professionals and caregivers when taking Abilify. 
• Cardiovascular disease: Patients with known cardiovascular problems such as heart attack, heart failure, ischemic heart disease, or heart rate problems will require close monitoring when taking Abilify. 
• Cerebrovascular disease: People with a history of strokes or other cerebrovascular problems will also need careful monitoring.
• Diabetes: Antipsychotics, including Abilify, can cause high blood sugar, so regular blood sugar testing is required in people with diabetes or prediabetes.
• Low blood pressure, low blood volume, or dehydration: Because Abilify can cause blood pressure problems, any condition that raises the risk of low blood pressure will require monitoring when Abilify is prescribed.
• Seizure disorders: Abilify can cause seizures, so people with a history of seizures will be prescribed Abilify with caution. 
• History of low white blood cell counts: People predisposed to problems with white blood cells will need to have regular blood tests to monitor the effects of Abilify on white blood cells.
• Aspiration pneumonia: Abilify can make swallowing difficult, raising the risk that food or drink will be aspirated and possibly cause aspiration pneumonia. People who are at risk for aspiration pneumonia will require close monitoring.

Finally, aripiprazole can throw off the body’s ability to regulate body temperature, resulting in hyperthermia or hypothermia. People taking Abilify then, are vulnerable to extreme environmental temperatures. They should be cautious when temperatures get too hot or too cold, dress appropriately, and even limit going outside when the weather is extreme. 

Pregnancy and nursing

Women who are pregnant or considering pregnancy should consult with a healthcare provider about the benefits and risks of taking Abilify while pregnant. There is no evidence that Abilify will harm a fetus, but when atypical antipsychotics are taken during the third trimester, there is a risk that babies will be born with withdrawal symptoms and extrapyramidal side effects (involuntary movement problems). 

Women who are breastfeeding should talk to their healthcare provider. Aripiprazole is present in human breast milk and there are reports of reduced milk production in lactating women and poor weight gain in nursing infants.

Children

The U.S. Food and Drug Administration (FDA) has approved Abilify to treat schizophrenia in children as young as 13 years of age, bipolar I disorder in children as young as 10 years of age, and Tourette syndrome or autistic disorder in children as young as 6 years of age. Because of the increased risk for suicide, children and adolescents will need to be closely watched for worsening depression, thoughts of suicide, or suicidal behaviors.

Older adults

People ages 65 and older can take Abilify in the same doses as younger adults, but the starting dose may be lower. However, there is an increased risk for falls and other injuries, so other drugs that cause sleepiness or impairment may need to be adjusted. Healthcare providers are also advised not to use Abilify in seniors with dementia-related psychosis.

Abilify interactions

Like other antipsychotic medications, Abilify has several potentially harmful drug interactions. 

• Antipsychotic drugs: First-generation and atypical antipsychotics produce many of the same side effects as Abilify. Combining more than one antipsychotic, then, increases the risk and possibly the severity of side effects.
• CNS depressants: Abilify reduces symptoms of schizophrenia and mania because it slows down the brain, that is, it is a central nervous system depressant. Many of the side effects such as fatigue, sleepiness, dizziness, and lightheadedness are due to the depressant effects of Abilify. Combining Abilify with other CNS depressants will worsen mental impairment and coordination problems caused by Abilify, and can slow or even stop breathing. These especially include sleeping pills, barbiturates, anxiety medications, opioid pain relievers, muscle relaxants, benzodiazepines, and alcohol, among others.
• Drugs that increase the side effects of aripiprazole: Some drugs block the ability of the liver to break down aripiprazole and its active metabolite, causing aripiprazole to stay in the bloodstream at higher concentrations for a longer period. The strongest inhibitors of aripiprazole, such as the antidepressants Prozac (fluoxetine) and Paxil (paroxetine), the antifungal drugs ketoconazole or itraconazole, or the heart rhythm drug quinidine may require the Abilify dose to be cut in half.
• Drugs that reduce the effectiveness of aripiprazole: Some drugs speed up the body’s metabolism of aripiprazole, such as carbamazepine. These drugs reduce the effectiveness of Abilify, so the Abilify dose may need to be increased.
• Blood pressure medications: Abilify can lower blood pressure, so careful blood pressure monitoring is required when it’s combined with blood pressure medications.

How to avoid Abilify side effects

Most people taking antipsychotic medications will experience side effects. Abilify is no exception, though some of the most unpleasant side effects of traditional antipsychotics are less common when taking Abilify. Still, there are many good rules of thumb for avoiding or minimizing side effects when taking Abilify.

1. Tell the healthcare provider about all medical conditions and medications

For any prescription drug, the first line of defense against side effects is to make sure that the prescribing healthcare provider has a complete medical history. For Abilify, the healthcare provider particularly needs to know about:

• Diabetes or a family history of high blood sugar
• Seizures
• High or low blood pressure
• Heart problems
• Stroke
• Low white blood cell counts
• Pregnancy or pregnancy plans
• Breastfeeding or plans to breastfeed

Side effects can also be due to drug interactions. The best way to avoid drug interactions is to keep a list of all drugs being taken including prescription or over-the-counter drugs as well as dietary supplements and herbal remedies. Always share this list with the prescribing healthcare provider. 

2. Keep all appointments

Visits with the prescribing healthcare provider are another important defense against side effects. If there are side effects, keep a list and share it with the healthcare provider at each visit. The healthcare provider may be able to prescribe other drugs to help with certain side effects such as headache, constipation, or tremor—or, change the dose or the medication altogether. Sleeplessness could be solved by changing the timing of each day’s dose. Finally, tests may need to be regularly performed to spot problems before they turn into serious medical problems.

3. Watch for symptoms of potentially serious side effects

Some side effects are or can develop into severe medical conditions. Abilify, unfortunately, has many severe side effects to watch out for, but there are signs and symptoms that signal there may be a serious problem, particularly:

• Seizures
• Weakness
• High fever
• Chills
• Excessive sweating
• Slow, fast, or uneven heartbeat
• Extreme hunger or thirst
• Increased urination
• Unusual urges or compulsions
• Severe agitation
• Feeling lightheaded or dizzy when standing up
• Difficulty swallowing
• Uncontrolled muscle movement or shaking
• Hives, rash, or swelling
• Unusual bruising or bleeding

If any of these problems are noticed while taking Abilify, immediately call a healthcare professional for medical advice or seek emergency medical attention when needed.

4. Take Abilify as directed

Take Abilify exactly as instructed. Do not change the doses or stop taking Abilify without getting the medical advice of the prescribing healthcare provider.

5. Do not miss doses

Abilify doses need to be taken daily to provide maximum therapeutic benefits. If a dose is missed, take it as soon as it’s remembered. If it’s almost time for the next dose, however, skip the missed dose and take the next dose on time. Do not double up on doses. If missing doses becomes a problem, a pharmacist can provide useful tools to help remember doses such as alarms, pillboxes, smartphone apps, and even pill bottle caps that have alarms. Or, you may want to talk to your doctor about other forms of Abilify such as Abilify MyCite or Abilify Maintena.

6. Don’t drink alcohol

As a drug that slows down the brain, Abilify doesn’t mix well with alcohol. The combination will worsen mental impairment and increase the risk of falling and accidents. It can also decrease blood pressure and cause breathing to slow or even stop.

7. Be careful about driving and other risky activities

Abilify can cause sleepiness, blurred vision, and mental impairment. Use good judgment about driving or engaging in risky activities. Do not drive until you know how Abilify affects you. You shouldn’t drive if you experience side effects such as blurred vision.