What are the dangers of aripiprazole (Abilify)?

From the Guidelines

Aripiprazole poses significant risks to patients, including increased mortality in elderly patients with dementia-related psychosis, metabolic changes, movement disorders, and potential interactions with other medications, emphasizing the need for careful monitoring and consideration of these risks in clinical practice. The medication can cause metabolic changes, such as weight gain, elevated blood sugar, and increased cholesterol levels, potentially leading to diabetes, as noted in a 2024 study on diabetes diagnosis and classification 1. Aripiprazole may also trigger akathisia (severe restlessness) and other movement disorders, such as tardive dyskinesia, which can become permanent. Some patients experience compulsive behaviors like pathological gambling, hypersexuality, or compulsive shopping.

Key Risks and Considerations

• Increased risk of death in elderly patients with dementia-related psychosis
• Metabolic changes, including weight gain, elevated blood sugar, and increased cholesterol levels
• Movement disorders, such as akathisia and tardive dyskinesia
• Compulsive behaviors, like pathological gambling or hypersexuality
• Sedation, dizziness, and orthostatic hypotension, increasing fall risk
• Potential to worsen depression and suicidal thoughts, particularly in adolescents
• Risk of neuroleptic malignant syndrome, a rare but life-threatening reaction

According to a 2018 study on delirium in adult cancer patients, aripiprazole may offer benefit in the symptomatic management of delirium, but its use should be limited to patients with distressing delirium symptoms or safety concerns, and medications should be used in the lowest effective dose and for a short period of time only 1. Patients should report concerning symptoms immediately and never stop taking aripiprazole abruptly without medical supervision. The medication requires careful monitoring, especially when combined with other medications, due to potential interactions.

Monitoring and Management

• Regular screening for prediabetes or diabetes, particularly in patients taking second-generation antipsychotic medications like aripiprazole
• Monitoring for signs of metabolic changes, movement disorders, and compulsive behaviors
• Careful consideration of the risks and benefits of aripiprazole in clinical practice, particularly in vulnerable populations like the elderly and adolescents.

From the FDA Drug Label

Aripiprazole tablets may cause serious side effects, including: • Stroke in elderly people (cerebrovascular problems) that can lead to death • Neuroleptic malignant syndrome (NMS): • Uncontrolled body movements (tardive dyskinesia). • Problems with your metabolism such as: • High blood sugar (hyperglycemia) and diabetes: • Unusual urges. • Orthostatic hypotension (decreased blood pressure): • Falls. • Low white blood cell count • Seizures (convulsions) • Problems with control of your body temperature • Difficulty swallowing that can cause food or liquid to get into your lungs

The dangers of aripiprazole include:

• Serious side effects: such as stroke, neuroleptic malignant syndrome, and uncontrolled body movements
• Metabolic problems: such as high blood sugar and diabetes
• Unusual urges: such as gambling, binge eating, and compulsive shopping
• Increased risk of falls: due to orthostatic hypotension and decreased blood pressure
• Low white blood cell count: which can increase the risk of infection
• Seizures: which can be a serious and potentially life-threatening side effect
• Problems with body temperature regulation: which can increase the risk of heat-related illnesses
• Difficulty swallowing: which can increase the risk of choking and aspiration pneumonia 2 2 2

From the Research

Dangers of Aripiprazole

• The use of aripiprazole has been associated with various side effects, including metabolic changes, weight gain, and increased risk of cardiovascular disease 3, 4, 5.
• A study published in 2004 found that aripiprazole exhibited a favorable safety and tolerability profile, with a low propensity to cause extrapyramidal symptoms, weight gain, cardiovascular abnormalities, hyperprolactinemia, hypercholesterolemia, or glucose dysregulation 6.
• However, a 2018 study found that after 1 year of treatment, patients taking aripiprazole had significant increments in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and the triglyceride/HDL index, leading to increments in obesity, hypertriglyceridemia, and hypercholesterolemia 3.
• A 2025 study found that patients prescribed aripiprazole had similar total cholesterol levels after 1 year to those prescribed olanzapine, quetiapine, and risperidone, but had better outcomes on other cardiometabolic parameters, such as body weight and blood pressure, especially compared to olanzapine 4.
• A 2014 review of real-world data found that aripiprazole was associated with a lower risk of metabolic adverse events, including weight gain and dyslipidemia, compared to other atypical antipsychotics 5.
• A 2011 review found that aripiprazole may be effective in treating anxiety disorders, but noted that large randomized, controlled trials were lacking 7.

Metabolic Effects

• Aripiprazole has been associated with significant increments in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and the triglyceride/HDL index 3.
• However, aripiprazole may have a lower risk of metabolic adverse events, including weight gain and dyslipidemia, compared to other atypical antipsychotics 5.
• Aripiprazole has been found to have a favorable safety and tolerability profile, with a low propensity to cause extrapyramidal symptoms, weight gain, cardiovascular abnormalities, hyperprolactinemia, hypercholesterolemia, or glucose dysregulation 6.

Cardiometabolic Safety

• A 2025 study found that patients prescribed aripiprazole had similar total cholesterol levels after 1 year to those prescribed olanzapine, quetiapine, and risperidone 4.
• Aripiprazole may have a lower risk of metabolic adverse events, including weight gain and dyslipidemia, compared to other atypical antipsychotics 5.
• Aripiprazole has been found to have a favorable safety and tolerability profile, with a low propensity to cause extrapyramidal symptoms, weight gain, cardiovascular abnormalities, hyperprolactinemia, hypercholesterolemia, or glucose dysregulation 6.