What are the side effects of Aripiprazole (Abilify)?

Side Effects of Aripiprazole (Abilify)

Aripiprazole commonly causes akathisia, sedation/somnolence, headache, nausea, vomiting, and weight gain as its primary side effects, with more serious but less common effects including metabolic changes, tardive dyskinesia, and neuroleptic malignant syndrome. 1

Common Side Effects

Neurological Effects

• Akathisia (inner sense of restlessness/need to move) - one of the most frequently reported side effects 1
• Somnolence/sedation - particularly common in children 1
• Headache - reported in both adult and pediatric populations 1
• Dizziness - can contribute to fall risk, especially in elderly patients 1
• Blurred vision - affects daily functioning 1

Gastrointestinal Effects

• Nausea and vomiting - among the most common side effects 1
• Constipation - frequently reported in adults 1
• Increased salivation/drooling - particularly in pediatric patients 1

Metabolic Effects

• Weight gain - though less severe compared to other atypical antipsychotics like olanzapine and quetiapine 2, 1
• Metabolic changes - including potential increases in blood glucose, cholesterol, and triglycerides 1

Serious Side Effects

Cardiovascular Effects

• Orthostatic hypotension - causing lightheadedness or fainting when standing up quickly 1
• QT prolongation - though reported to have a lower incidence compared to other antipsychotics 3

Neurological Complications

• Tardive dyskinesia - uncontrolled body movements that may not resolve with discontinuation 1
• Neuroleptic malignant syndrome (NMS) - rare but potentially fatal condition with symptoms including high fever, muscle stiffness, confusion, and changes in vital signs 1
• Seizures - reported as a potential adverse effect 1

Other Serious Concerns

• Increased risk of stroke in elderly patients with dementia-related psychosis 1
• Unusual urges - including gambling, compulsive eating, shopping, and sexual urges 1
• Low white blood cell count - including rare cases of neutropenia 4
• Cognitive impairment - though potentially less than other antipsychotics 5

Population-Specific Considerations

Pediatric Patients

• Higher rates of:
  • Somnolence
  • Increased appetite
  • Fatigue
  • Uncontrolled movements
  • Drooling 1

Elderly Patients

• Increased mortality risk in elderly patients with dementia-related psychosis 1
• Higher risk of stroke in elderly populations 1
• Greater susceptibility to falls due to dizziness and sedation 1

Therapeutic Drug Monitoring Considerations

• Optimal therapeutic response with minimal side effects has been observed with serum levels between 150-300 ng/ml 6
• Patients with levels between 110-249 ng/ml typically experience no or only mild side effects 6
• Significant inter-individual variability in serum levels exists, even with the same dosage 6

Unique Aspects of Aripiprazole

Unlike many other antipsychotics, aripiprazole:

• Has a partial agonist effect at dopamine D2 receptors, which may contribute to its different side effect profile 7, 8
• Shows lower incidence of hyperprolactinemia compared to other antipsychotics 7
• Has a relatively high therapeutic index, suggesting better safety in overdose situations 3

Management of Side Effects

• Akathisia: Consider dose reduction if severe 2
• Metabolic effects: Regular monitoring of weight, blood glucose, and lipid profiles is recommended 1
• Sedation: Dosing at bedtime may help manage this side effect
• Temperature regulation issues: Ensure adequate hydration, especially during exercise or hot weather 1

Remember that aripiprazole has a unique pharmacological profile as a partial agonist at D2 receptors, which contributes to its distinctive side effect profile compared to other antipsychotics.