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Resources › Psychotropics A-Z › Aripiprazole | Abilify | Abilify
Atypical (Second-Generation) Antipsychotic

Aripiprazole | Abilify

Clinical Overview

Aripiprazole is an atypical antipsychotic with a unique mechanism as a dopamine D2 receptor partial agonist, indicated for schizophrenia, bipolar disorder, major depressive disorder (adjunctive), autism spectrum disorder irritability, and Tourette’s disorder. It is available in multiple formulations including oral, long-acting injectable, and digital pill with sensor.

Primary Clinical Applications

Aripiprazole is indicated for schizophrenia, manic/mixed episodes of bipolar I disorder, maintenance treatment of bipolar I disorder, adjunctive treatment of major depressive disorder, irritability associated with autism spectrum disorder (pediatric), and Tourette’s disorder (pediatric). Its broad indications reflect its versatile therapeutic profile.

Mechanism and Clinical Benefits

Aripiprazole acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors. This “functional selectivity” allows it to stabilize dopamine activity – reducing it when excessive and increasing it when deficient – potentially providing efficacy with fewer side effects.

Formulation Options

Available as oral tablets, orally disintegrating tablets, oral solution, monthly injection (Abilify Maintena), long-acting injection (Aristada – monthly, every 6 weeks, or every 2 months), and digital pill with ingestion sensor (Abilify MyCite) for adherence monitoring.

Prescribing Information

Dosing & Administration

Schizophrenia – Adults:

  • Initial: 10-15 mg once daily
  • Range: 10-30 mg daily
  • Maximum: 30 mg daily

Bipolar I Disorder – Manic/Mixed Episodes:

  • Adults: 15 mg once daily initially, range 15-30 mg daily
  • Pediatric (10-17 years): 2 mg daily initially, target 10 mg daily

Major Depressive Disorder (Adjunctive) – Adults:

  • Initial: 2-5 mg once daily
  • Range: 2-15 mg daily
  • Titrate: Increase by 5 mg at intervals ≥1 week

Autism Spectrum Disorder – Pediatric (6-17 years):

  • Initial: 2 mg daily
  • Target: 5-15 mg daily based on weight
  • <15 kg: 5 mg daily; ≥15 kg: 10-15 mg daily

Tourette’s Disorder – Pediatric (6-18 years):

  • Initial: 2 mg daily
  • Target: 5-20 mg daily based on weight and response

Long-Acting Injections:

  • Abilify Maintena: 400 mg IM monthly
  • Aristada: 441-882 mg IM monthly, or extended intervals

Indications

  • Treatment of schizophrenia (adults and adolescents 13-17 years)
  • Treatment of manic or mixed episodes associated with bipolar I disorder (adults and pediatric patients 10-17 years)
  • Maintenance treatment of bipolar I disorder (adults)
  • Adjunctive treatment of major depressive disorder (adults)
  • Treatment of irritability associated with autistic disorder (pediatric patients 6-17 years)
  • Treatment of Tourette’s disorder (pediatric patients 6-18 years)

Contraindications

  • Known hypersensitivity to aripiprazole or any component
  • No absolute contraindications

Warnings & Precautions

  • Boxed Warning: Increased mortality in elderly patients with dementia-related psychosis; increased suicidal risk in children, adolescents, and young adults (depression indication)
  • Neuroleptic malignant syndrome: Rare but serious risk
  • Tardive dyskinesia: Risk with long-term use
  • Metabolic changes: Monitor glucose, lipids, and weight
  • Orthostatic hypotension: Monitor blood pressure
  • Seizures: Use caution in patients with seizure history
  • Cognitive and motor impairment: May affect ability to drive

Drug Interactions

  • Strong CYP3A4 inhibitors: Reduce aripiprazole dose by 50%
  • Strong CYP2D6 inhibitors: Reduce aripiprazole dose by 50%
  • Strong CYP3A4 inducers: Double the aripiprazole dose
  • Combined strong inhibitors: Reduce dose by 75%

Adverse Reactions

Common (≥5%) – Adults:

  • Nausea, vomiting, constipation, headache, dizziness
  • Akathisia, anxiety, insomnia, restlessness

Common – Pediatric:

  • Sedation, fatigue, weight gain, vomiting
  • Somnolence, tremor, extrapyramidal disorder

Special Populations

  • CYP2D6 poor metabolizers: Reduce dose by 50%
  • Hepatic Impairment: No dose adjustment for mild-moderate impairment
  • Renal Impairment: No dose adjustment needed
  • Elderly: Increased mortality risk in dementia-related psychosis
  • Pregnancy: Category C – use only if benefits outweigh risks
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.