What are the side effects of Abilify (aripiprazole)?

Abilify (Aripiprazole) Side Effects

Abilify causes a range of side effects from common benign symptoms like nausea and headache to serious life-threatening complications including increased death risk in elderly dementia patients, neuroleptic malignant syndrome, and suicidal thoughts in young adults. 1

Serious and Life-Threatening Side Effects

Black Box Warnings

• Increased mortality in elderly patients with dementia-related psychosis - aripiprazole is not approved for this population and significantly raises death risk 1
• Suicidal thoughts and actions - particularly in children, teenagers, and young adults within the first few months of treatment, requiring close monitoring for new or worsening depression, anxiety, agitation, panic attacks, insomnia, irritability, aggressive behavior, or suicidal ideation 1

Severe Neurological Complications

• Neuroleptic malignant syndrome (NMS) - a rare but potentially fatal condition presenting with high fever, muscle rigidity, confusion, sweating, and changes in pulse, heart rate, and blood pressure; requires immediate medical attention 1, 2
• Tardive dyskinesia - uncontrolled movements of face, tongue, or other body parts that may be irreversible even after discontinuation 1
• Seizures (convulsions) - reported in clinical use and require monitoring 1, 2

Cardiovascular Effects

• Orthostatic hypotension - lightheadedness or fainting when rising from sitting or lying position, which can lead to falls and fractures 1
• Stroke risk in elderly patients (cerebrovascular problems) that can be fatal 1

Common Side Effects

In Adults

The most frequently reported adverse effects include 1, 3:

• Nausea and vomiting
• Headache
• Dizziness and lightheadedness
• Anxiety
• Insomnia
• Constipation
• Restlessness and akathisia (inner sense of restlessness/need to move)
• Blurred vision
• Upper respiratory illness

In Children and Adolescents

Pediatric patients experience a somewhat different profile 1, 2:

• Feeling sleepy or drowsy
• Insomnia (paradoxically also reported)
• Headache
• Nausea and vomiting
• Stuffy nose
• Fatigue
• Weight gain
• Increased or decreased appetite
• Uncontrolled movements (restlessness, tremor)
• Increased saliva or drooling
• Muscle stiffness
• Severe adverse events including extreme insomnia, Parkinsonism, behavioral changes, psychoses, and suicidal behavior have been reported to health authorities 2

Metabolic and Endocrine Effects

Blood Sugar and Weight

• Hyperglycemia and diabetes - increases in blood sugar can occur, with extremely high levels potentially leading to coma or death; patients should be monitored for excessive thirst, frequent urination, hunger, weakness, fatigue, nausea, confusion, or fruity-smelling breath 1
• Weight gain - occurs in approximately 12% of patients, with some experiencing 5-10% decreases in body weight; regular weight monitoring is essential 1
• Increased cholesterol and triglycerides in blood 1

Other Metabolic Issues

• Low white blood cell count - requires monitoring 1

Behavioral and Psychiatric Side Effects

Emotional Blunting

• Anxiety, agitation, and changes in emotional responsiveness - aripiprazole can cause emotional blunting, particularly manifesting as anxiety and agitation 4
• Headache and insomnia may contribute to emotional dysregulation 4
• Patients with poor cytochrome P450 2D6 metabolism may experience more frequent emotional side effects 4

Impulse Control Disorders

• Unusual urges - some patients develop pathological gambling, binge eating, compulsive eating, compulsive shopping, and increased sexual urges; family members should be alerted to watch for these behaviors 1

Temperature Regulation and Physical Safety

• Problems with body temperature control - especially during exercise or in hot environments; patients must stay hydrated, avoid heavy clothing, and drink plenty of water 1
• Falls - due to sleepiness, dizziness, decreased blood pressure when changing position, and slowed thinking/motor skills, leading to fractures or other injuries 1
• Difficulty swallowing - can cause aspiration of food or liquid into lungs 1

Special Population Considerations

Elderly Patients

• More sensitive to medication effects, including emotional side effects 4
• Lower doses recommended 5
• Higher risk of falls and cardiovascular complications 1

Poor Metabolizers

• Patients with poor cytochrome P450 2D6 metabolism require dose adjustments and may experience more frequent side effects 4, 5

Clinical Pearls and Monitoring

Aripiprazole has a relatively favorable side effect profile compared to other antipsychotics, with lower rates of extrapyramidal symptoms (though risk increases at higher doses), minimal weight gain in most patients, and low affinity for histamine, muscarinic, and alpha-1 adrenergic receptors 5, 6, 7

However, the serious risks—particularly in vulnerable populations like elderly dementia patients and young adults—require vigilant monitoring and appropriate patient selection 1, 2