What are the side effects of Abilify (aripiprazole)?

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Abilify (Aripiprazole) Side Effects

Aripiprazole (Abilify) can cause several significant side effects including somnolence, weight gain, extrapyramidal symptoms (particularly akathisia), metabolic changes, and unusual urges such as gambling or compulsive behaviors. 1

Common Side Effects

Aripiprazole's FDA label identifies the following common side effects:

In Adults:

  • Nausea
  • Vomiting
  • Constipation
  • Headache
  • Dizziness
  • Anxiety
  • Insomnia
  • Blurred vision
  • Restlessness/akathisia (inner sense of needing to move)
  • Upper respiratory illness 1

In Children:

  • Drowsiness/sleepiness
  • Headache
  • Insomnia
  • Nausea and vomiting
  • Stuffy nose
  • Fatigue
  • Weight gain
  • Changes in appetite (increased or decreased)
  • Uncontrolled movement/restlessness/tremor
  • Increased saliva or drooling
  • Muscle stiffness 1

Serious Side Effects

Several serious side effects require immediate medical attention:

  1. Cerebrovascular Events: Stroke in elderly patients with dementia-related psychosis that can lead to death (aripiprazole is not approved for dementia-related psychosis) 1

  2. Neuroleptic Malignant Syndrome (NMS): A potentially fatal condition characterized by:

    • High fever
    • Stiff muscles
    • Confusion
    • Sweating
    • Changes in pulse, heart rate, and blood pressure 1

  3. Tardive Dyskinesia: Uncontrolled body movements in face, tongue, or other body parts that may not resolve even after stopping the medication 1

  4. Metabolic Changes:

    • Hyperglycemia and diabetes
    • Increased cholesterol and triglycerides
    • Weight gain 1

  5. Unusual Urges: Some patients experience:

    • Gambling urges
    • Compulsive eating
    • Compulsive shopping
    • Unusual sexual urges 1

  6. Orthostatic Hypotension: Lightheadedness or fainting when standing up quickly 1

  7. Falls Risk: Due to sedation, dizziness, and blood pressure changes 1

  8. Low White Blood Cell Count 1

  9. Seizures 1

  10. Body Temperature Regulation Problems: Especially during exercise or in hot environments 1

  11. Dysphagia: Difficulty swallowing that can lead to aspiration 1

Side Effects in Special Populations

Children and Adolescents

In clinical trials for autism spectrum disorder, aripiprazole demonstrated efficacy for irritability but showed side effects including:

  • Somnolence
  • Weight gain
  • Drooling
  • Tremor
  • Fatigue
  • Vomiting 2

Elderly Patients

Elderly patients are at increased risk for:

  • Cerebrovascular events (stroke)
  • Dehydration complications
  • Falls 1

Monitoring Recommendations

Based on the side effect profile, patients on aripiprazole should be monitored for:

  1. Metabolic Parameters:

    • Weight and BMI
    • Blood glucose
    • Lipid profile 2

  2. Movement Disorders:

    • Akathisia (restlessness)
    • Tardive dyskinesia
    • Extrapyramidal symptoms 1

  3. Mental Status:

    • New or worsening depression
    • Suicidal thoughts or behaviors
    • Unusual urges or behaviors 1

  4. Cardiovascular Parameters:

    • Blood pressure (especially orthostatic changes)
    • Heart rate
    • QT interval if overdose is suspected 1

Managing Side Effects

For akathisia (one of the most common troublesome side effects):

  • Dose reduction may help
  • Switching to quetiapine or olanzapine could be considered
  • Adjunctive propranolol (10-30 mg two to three times daily) may provide relief 2

For metabolic side effects:

  • Regular monitoring of weight, blood glucose, and lipid profiles
  • Lifestyle modifications (diet and exercise)
  • Consider medication change if significant metabolic issues develop 2

Drug Interactions

Aripiprazole is metabolized by cytochrome P450 enzymes (primarily CYP3A4 and CYP2D6), leading to potential interactions with:

  • Strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin) - may decrease aripiprazole effectiveness
  • Strong CYP3A4 or CYP2D6 inhibitors - may increase aripiprazole levels and side effects 1

Overdose Considerations

In overdose situations, reported effects include:

  • Vomiting
  • Somnolence
  • Tremor
  • Possible QT prolongation
  • Respiratory depression in severe cases 1

Management of overdose focuses on supportive care, maintaining airway, and cardiac monitoring if QT prolongation occurs. Activated charcoal may be useful if administered within one hour of ingestion 1.

References

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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