Does Abilify (Aripiprazole) Affect Triglycerides?
Aripiprazole has minimal to no clinically significant effect on triglyceride levels and is generally considered metabolically favorable compared to other atypical antipsychotics. 1
Evidence from FDA Drug Labeling
The FDA prescribing information for aripiprazole demonstrates no significant differences in triglyceride changes compared to placebo:
- In adult patients, fasting triglycerides showed similar rates of conversion from normal to high (≥200 mg/dL) between aripiprazole (7.4%) and placebo (7.0%) in pooled trials 1
- At 12 weeks, the proportion with normal-to-high triglyceride changes was 12.9% for aripiprazole versus 13.5% for placebo 1
- At 24 weeks, rates were 14.7% for aripiprazole versus 25% for placebo 1
- In adolescent patients, normal-to-high triglyceride changes occurred in 3.7% on aripiprazole versus 4.7% on placebo 1
Comparative Metabolic Profile
When switching from other antipsychotics to aripiprazole, metabolic parameters typically improve rather than worsen:
- Switching from other second-generation antipsychotics to aripiprazole resulted in significant decreases in total cholesterol (-28.8 mg/dL) and LDL (-20.75 mg/dL), though triglycerides showed no significant change 2
- When specifically switching from olanzapine to aripiprazole, improvements were even more pronounced, with total cholesterol decreasing by -32.0 mg/dL and weight decreasing by -16.7 pounds 2
- Adding aripiprazole to stable olanzapine therapy in overweight patients resulted in significant triglyceride reductions (p=0.001), along with decreases in VLDL cholesterol 3
Important Clinical Caveats
Despite the generally favorable profile, rare cases of aripiprazole-induced hypertriglyceridemia have been reported:
- Three case reports documented serious aripiprazole-related dyslipidemia in young subjects, suggesting that while uncommon, hypertriglyceridemia can occur 4
- One case showed resolution of severe clozapine-induced hyperlipidemia (triglycerides 4758 mg/dL) after switching to aripiprazole, with lipid levels improving dramatically 5
Monitoring Recommendations
Based on the evidence, triglyceride monitoring should still occur but with lower concern than with other antipsychotics:
- Obtain baseline fasting lipid panel before initiating aripiprazole 1
- Recheck lipids at 12 weeks, particularly in patients with pre-existing metabolic risk factors 4
- Continue periodic monitoring as clinically indicated, especially in patients with baseline dyslipidemia 4
Context Among Antipsychotics
Aripiprazole is not listed among medications that genuinely elevate triglycerides (such as atypical antipsychotics like olanzapine, beta-blockers, thiazides, corticosteroids, or bile acid sequestrants) in major cardiovascular guidelines 6. This distinguishes it from many other antipsychotics that carry more substantial metabolic risk.