Side Effects of Abilify (Aripiprazole) Intramuscular Injection
Aripiprazole intramuscular (IM) injection can cause several side effects, with the most common being injection site reactions, sedation, and headache, though it generally has a favorable safety profile compared to other antipsychotics.
Common Side Effects
- Injection site reactions: Pain, erythema, and allergic reactions at the injection site are usually mild 1
- Neurological effects: Headache, dizziness, drowsiness, and sedation are frequently reported 2, 3
- Psychiatric effects: Agitation, anxiety, and insomnia may occur 2
- Extrapyramidal symptoms (EPS): Aripiprazole has a lower risk of EPS compared to first-generation antipsychotics like haloperidol 1, 4
Cardiovascular Effects
- QTc prolongation: Aripiprazole has a low risk of QTc prolongation compared to other antipsychotics 1, 5
- Orthostatic hypotension: Risk is lower than with other antipsychotics, but monitoring is still recommended 1, 5
Metabolic and Endocrine Effects
- Hyperprolactinemia: Aripiprazole has a low risk of causing elevated prolactin levels 2, 1
- Weight gain: Less likely to cause significant weight gain compared to other antipsychotics 2
- Metabolic disturbances: Lower risk of diabetes and dyslipidemia compared to other antipsychotics 2, 1
Rare but Serious Side Effects
- Tardive dyskinesia: Although less common than with typical antipsychotics, aripiprazole can still cause tardive dyskinesia with long-term use 6
- Neuroleptic malignant syndrome: Rare but potentially life-threatening condition 2
- Severe allergic reactions: May occur in rare cases 1
Dosing and Administration Considerations
- Standard IM dose: 9.75 mg for acute agitation in schizophrenia or bipolar disorder 3, 4
- Onset of action: Clinical improvement can begin as early as 30 minutes after injection, with significant effects seen at 90-120 minutes 3
- Duration: Effects are sustained for up to 24 hours 3
- Repeat dosing: If needed, additional doses can be administered at least 2 hours after the first injection 4
Special Populations
- Pregnancy: Should only be used if benefits justify potential risks to the fetus 2
- Breastfeeding: Interruption of breastfeeding may be prudent 2
- Elderly patients: Lower doses may be required due to increased sensitivity to side effects 2
- Patients with renal or hepatic impairment: Dose adjustments may be necessary 2
Advantages Over Other IM Antipsychotics
- Lower risk of extrapyramidal symptoms: EPS rates with aripiprazole IM (1.7%) are similar to placebo (2.3%) and significantly lower than haloperidol (12.6%) 4
- High therapeutic index: Overdose cases suggest a favorable safety profile with limited clinical effects even at high serum levels 5
- Less sedation: Compared to first-generation antipsychotics like haloperidol 1
Monitoring Recommendations
- Vital signs: Monitor before, during, and after injection until stable 2
- Mental status: Assess for changes in agitation levels and potential adverse psychiatric effects 3
- Movement disorders: Watch for signs of akathisia, dystonia, or other extrapyramidal symptoms 6
Aripiprazole IM injection is generally well-tolerated and has a favorable side effect profile compared to other antipsychotics used for acute agitation, making it a valuable treatment option for patients with schizophrenia or bipolar disorder requiring rapid symptom control 1, 4.