What are the uses of Abilify (aripiprazole)?

Uses of Abilify (Aripiprazole)

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

Primary Indications

Schizophrenia

• Approved for adults and adolescents (13-17 years)
• Effective for both acute treatment and maintenance therapy
• Dosing:
  • Adults: 10-30 mg/day
  • Adolescents: 10 mg/day initially, with option to increase to 30 mg/day if needed 1
• Demonstrated efficacy in reducing PANSS scores in multiple clinical trials
• Maintenance therapy significantly delays relapse compared to placebo 1

Bipolar I Disorder

• Approved for:
  • Acute manic and mixed episodes (monotherapy)
  • Maintenance treatment (monotherapy)
  • Adjunctive maintenance therapy with lithium or valproate 1
• Effective in preventing both manic and depressive relapses
• Superior to placebo in time to relapse in maintenance studies 1
• Particularly effective when combined with lithium or valproate for inadequate responders to mood stabilizer monotherapy 2

Major Depressive Disorder (MDD)

• Approved as adjunctive therapy to antidepressants for adults with MDD
• Effective for patients who have had inadequate response to antidepressant monotherapy 3
• Demonstrated efficacy in multiple 6-week clinical trials 3
• Augmentation with aripiprazole has shown higher remission rates compared to some other augmentation strategies (55.4% vs 34.0% for bupropion augmentation) 4

Additional Uses

Treatment-Resistant Cases

• Can be used as part of antipsychotic polypharmacy in treatment-resistant schizophrenia
• The combination of clozapine with aripiprazole has shown particular benefit in reducing risk of psychiatric hospitalization (HR 0.86,95% CI 0.79-0.94) 4
• May help address residual symptoms when used as part of combination therapy 2

Negative Symptoms in Schizophrenia

• Adding aripiprazole to another antipsychotic may improve negative symptoms 4
• Finnish Current Care Guidelines note that combining aripiprazole with another antipsychotic may reduce negative symptoms 4

Metabolic Profile Advantages

• Lower risk of metabolic disturbances compared to some other atypical antipsychotics 5
• Favorable cardiovascular tolerability profile 5
• When used as augmentation with other antipsychotics, may help reduce prolactin levels and body weight 4

Administration Forms

• Available as:
  • Oral tablets
  • Long-acting injectable (Abilify Maintena) for maintenance treatment of schizophrenia 5
  • The long-acting formulation may benefit patients stable on oral aripiprazole who would benefit from improved adherence 5

Side Effects and Monitoring

• Common side effects:
  • Akathisia (higher incidence than in schizophrenia when used for MDD) 3
  • Sedation
  • Weight gain (though minimal compared to other atypicals)
  • Extrapyramidal symptoms 6
• Requires baseline and regular monitoring of:
  • Weight and BMI
  • Blood pressure
  • Fasting glucose
  • Lipid profile 2
• Assess for extrapyramidal symptoms, particularly akathisia 2

Important Considerations

• Unique mechanism as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, unlike other atypical antipsychotics that primarily act as antagonists 6
• Half the usual dose should be used in CYP2D6 poor metabolizers 2
• For combination therapy, lower doses may be needed than when used as monotherapy 2
• When considering antipsychotic polypharmacy, monotherapy should be tried first, including clozapine when appropriate 2

Aripiprazole represents a valuable treatment option across multiple psychiatric conditions with a generally favorable side effect profile compared to many other antipsychotic medications.