Can Abilify (aripiprazole) and Seroquel (quetiapine) be given together?

Can Abilify and Seroquel Be Given Together?

Yes, Abilify (aripiprazole) and Seroquel (quetiapine) can be safely combined in clinical practice for treatment-resistant psychiatric conditions, particularly bipolar disorder and treatment-resistant depression, with appropriate monitoring for cardiac effects, sedation, and metabolic parameters. 1

Clinical Indications for Combination Therapy

• The American Academy of Child and Adolescent Psychiatry explicitly supports combining quetiapine and aripiprazole for treatment-resistant conditions or complex psychiatric presentations. 1

• This combination is particularly useful for treatment-resistant bipolar depression when monotherapy fails, as recommended by the American Psychiatric Association. 2

• Augmentation with second-generation antipsychotics, especially aripiprazole and quetiapine, is effective in patients with moderate-to-severe depression who have had suboptimal response to standard antidepressants. 3

Dosing Strategy

Start low and titrate slowly to minimize side effects:

• Initial quetiapine dose: 25 mg daily 4, 1

• Initial aripiprazole dose: 2.5-5 mg daily 4, 1

• Titrate gradually while monitoring for side effects, particularly in the first 24-48 hours after dosage changes. 4, 1

• In elderly patients or those with hepatic impairment, use even lower starting doses. 4, 1

Required Monitoring

ECG monitoring is mandatory, particularly in patients with cardiac risk factors, due to potential QT interval prolongation. 1

Additional monitoring parameters include:

• Metabolic parameters (weight, glucose, lipids) 1
• Neurological side effects (extrapyramidal symptoms, akathisia) 1
• Sedation levels (up to 83% with quetiapine, up to 97% with aripiprazole in some studies) 1
• Cognitive effects 1

Critical Drug Interactions

• Never combine with monoamine oxidase inhibitors (MAOIs) due to risk of serotonin syndrome. 4, 1

• Both medications are metabolized through the cytochrome P450 system, creating potential for drug interactions. 4, 1

• Aripiprazole may inhibit P-glycoprotein (P-gp), affecting metabolism of other medications. 1

Common Pitfalls and Side Effects

Akathisia risk: Aripiprazole carries a higher risk of akathisia, especially in the first few weeks of treatment, observed in up to 60% of patients. 1

Additive sedation: The combination produces additive sedative effects requiring careful monitoring. 1

Extrapyramidal symptoms: The combination increases risk of extrapyramidal side effects with long-term treatment. 5

Evidence Quality Note

While one older study (2009) showed no additional psychiatric symptom improvement when adding aripiprazole to quetiapine or risperidone in schizophrenia 6, and one case report (2012) described psychotic exacerbation with aripiprazole combinations 7, the most recent guideline evidence (2025) from the American Academy of Child and Adolescent Psychiatry clearly supports this combination with appropriate monitoring. 1 The combination is generally safe and well-tolerated when initiated at low doses with gradual titration. 1, 6