Drooling from Abilify (Aripiprazole)
Yes, drooling is a recognized side effect of Abilify (aripiprazole), though it occurs less frequently than with some other antipsychotics.
Evidence from FDA Labeling and Clinical Trials
The FDA-approved drug label for aripiprazole explicitly lists "increased saliva or drooling" as a common side effect in pediatric patients 1. This is documented in the official prescribing information and patient medication guide.
In randomized controlled trials of children and adolescents with autism spectrum disorder, drooling was identified as a significant side effect of aripiprazole at doses of 5-15 mg/day 2. The studies included 218-316 children aged 6-17 years, where drooling appeared alongside other side effects including somnolence, weight gain, tremor, fatigue, and vomiting 2.
Clinical Context and Mechanism
Aripiprazole-induced drooling represents a paradoxical effect, as the drug is not typically associated with the same degree of sialorrhea seen with clozapine 3. The mechanism likely involves the drug's unique dopamine-serotonin system stabilizing properties, which can affect salivary gland regulation through complex receptor interactions 3.
Case reports document that drooling from aripiprazole can manifest acutely, particularly in younger pediatric patients. A 6-year-old receiving therapeutic doses experienced lethargy, drooling, and flaccid facial muscles that improved with diphenhydramine 4. This suggests the side effect may be more pronounced in younger children compared to adolescents.
Clinical Significance
While drooling is listed as a side effect, it appears to be:
- More common in pediatric populations than adults 1
- Less severe than clozapine-associated sialorrhea 3, 5
- Potentially responsive to anticholinergic interventions when symptomatic treatment is needed 4
Management Considerations
If drooling becomes problematic on aripiprazole, consider:
- Dose reduction if clinically feasible while maintaining therapeutic benefit
- Anticholinergic agents such as glycopyrrolate or atropine for symptomatic relief 6
- Antihistamines like diphenhydramine, which showed benefit in one pediatric case 4
- Medication switch to an alternative antipsychotic if drooling significantly impacts quality of life 5
The drooling can lead to psychosocial complications, particularly in children and adolescents, affecting clothing, social interactions, and medication adherence 6, 7. Therefore, proactive monitoring and management are warranted when this side effect emerges.