Abilify (Aripiprazole): Uses and Indications
Abilify (aripiprazole) is primarily indicated for the treatment of schizophrenia, bipolar disorder (manic and mixed episodes), and as an adjunctive treatment for major depressive disorder. 1
Primary Indications
Schizophrenia: Abilify is FDA-approved for the treatment of schizophrenia in adults and adolescents (13-17 years old), helping to manage both positive and negative symptoms 1, 2
Bipolar I Disorder: Approved for the treatment of manic and mixed episodes associated with bipolar I disorder, both as monotherapy and as adjunctive therapy with lithium or valproate 1, 3
Major Depressive Disorder (MDD): Used as an adjunctive therapy to antidepressants for patients with MDD who have had an inadequate response to antidepressant therapy alone 4
Mechanism of Action
Abilify has a unique pharmacological profile as a partial agonist at dopamine D2 and D3 receptors and serotonin 5-HT1A receptors, while acting as an antagonist at serotonin 5-HT2A receptors 5, 6
This mechanism differs from other atypical antipsychotics that primarily act as dopamine D2 receptor antagonists, which may explain its different tolerability profile 3, 2
The partial agonist activity at dopamine D2 receptors is thought to contribute to its efficacy in treating both positive and negative symptoms of schizophrenia while reducing the risk of extrapyramidal symptoms 2
Off-Label Uses
Delirium management: Abilify may be used at doses of 5 mg orally or intramuscularly for the management of delirium in adult cancer patients, particularly when less sedation is desired 7
Alcohol dependence: Although evidence is limited, aripiprazole has been studied in the context of maintaining abstinence from alcohol, though acamprosate has stronger evidence for this indication 7
Dosing Considerations
Schizophrenia: Starting dose is typically 10-15 mg once daily, with efficacy demonstrated within the first few weeks of treatment 1, 2
Bipolar disorder: Usually initiated at 15 mg once daily, with demonstrated efficacy in reducing manic symptoms 1, 3
Adjunctive treatment for MDD: Typically started at lower doses (2-5 mg) and titrated as needed 4
Special populations: Lower doses are recommended for elderly patients, those with hepatic impairment, or poor metabolizers of cytochrome P450 2D6 7
Safety and Tolerability
Abilify generally has a favorable safety profile compared to other atypical antipsychotics, with minimal propensity for clinically significant weight gain and metabolic disruption 6, 2
Common side effects include:
Less likely to cause extrapyramidal symptoms (EPS) than first-generation antipsychotics, though the risk increases at higher doses 7
Important drug interactions occur with CYP3A4 and CYP2D6 inhibitors or inducers, requiring dosage adjustments 2
Clinical Considerations
Abilify may be particularly useful when a less sedating antipsychotic is desired 7
In combination therapy scenarios, such as with cariprazine, lower doses of each medication may be used to maintain efficacy while reducing side effects 8
For maintenance treatment of bipolar I disorder, Abilify has demonstrated superiority to placebo in preventing relapse of both manic and depressive episodes 1
Onset of action is relatively rapid, with significant improvement often observed within the first 1-2 weeks of treatment 2, 4