What are the indications for Abilify (aripiprazole)?

Indications for Abilify (Aripiprazole)

Aripiprazole (Abilify) is FDA-approved for the treatment of schizophrenia, bipolar I disorder (manic and mixed episodes), and as an adjunctive therapy to antidepressants for major depressive disorder. 1, 2, 3

FDA-Approved Indications

Primary Indications

• Schizophrenia

  • Approved for adults 1, 4
  • Effective for both positive and negative symptoms 5
  • Dosage range: 10-30 mg/day 2

• Bipolar I Disorder

  • Treatment of manic and mixed episodes 2, 6
  • Can be used as monotherapy or adjunctive therapy with lithium or valproate 6
  • Dosage range: 15-30 mg/day 2
  • Effective for acute treatment and maintenance therapy 6

• Major Depressive Disorder (MDD)

  • Approved as adjunctive therapy to antidepressants 3
  • Particularly useful when patients have had inadequate response to antidepressant monotherapy 3

Additional Approved Uses

• Irritability associated with autism 3

Pediatric Indications

• Bipolar I Disorder (manic/mixed episodes)

  • Approved for children and adolescents 7
  • Lithium is approved down to age 12 years, but aripiprazole is also used in pediatric populations 7

• Schizophrenia in adolescents

  • Limited data available on pediatric use 5
  • Weight-based dosing strategy may be required for children and adolescents 5

Pharmacological Properties

Aripiprazole has a unique mechanism of action that contributes to its efficacy and side effect profile:

• Partial agonist at dopamine D2 and D3 receptors 2, 5, 6
• Partial agonist at serotonin 5-HT1A receptors 2, 5, 6
• Antagonist at 5-HT2A receptors 2, 5, 6

Advantages Over Other Antipsychotics

• Low propensity for weight gain 2, 4
• Favorable metabolic profile 2, 4
• No association with hyperprolactinemia 2, 4
• Lower incidence of extrapyramidal symptoms compared to typical antipsychotics like haloperidol 6, 4
• No significant QT interval prolongation 6, 4

Dosing Considerations

• Schizophrenia: 10-30 mg/day 2
• Bipolar I Disorder: 15-30 mg/day 2
• MDD (adjunctive): Typically started at lower doses
• No dosage titration necessary for most patients 4
• Rapid onset of action, often within the first or second week of treatment 4

Important Clinical Considerations

• Aripiprazole may cause akathisia, particularly when used for bipolar disorder or depression 3, 6
• Gastrointestinal complaints may occur at treatment initiation but are often time-limited 2
• Lower starting doses may be appropriate when adding to or switching from another antipsychotic 2
• Long-term efficacy has been demonstrated for up to 52 weeks in schizophrenia 4
• May improve cognitive function in patients with schizophrenia 4

Comparative Efficacy

For schizophrenia, aripiprazole appears to be:

• Superior to placebo and haloperidol (long term)
• Similar in efficacy to perphenazine and risperidone
• Possibly inferior to olanzapine in efficacy, but with better tolerability profile 2

Aripiprazole represents a valuable treatment option with a unique pharmacological profile that offers efficacy across multiple psychiatric conditions while maintaining a favorable side effect profile compared to many other antipsychotic medications.