Side Effects of Aripiprazole
Aripiprazole has a favorable side effect profile compared to other antipsychotics, with minimal metabolic disruption and weight gain, but akathisia and other movement disorders remain clinically significant concerns that require monitoring. 1, 2
Common Side Effects
In Adults
The most frequently reported side effects include: 1
- Nausea - typically transient 1, 3
- Akathisia (inner restlessness/need to move) - can be dose-limiting, particularly in bipolar disorder and major depressive disorder 1, 2
- Insomnia 1, 3
- Headache 1, 4
- Dizziness 1
- Anxiety and agitation - usually transient 1, 3
- Constipation 1
- Vomiting 1
- Restlessness 1
- Blurred vision 1
- Upper respiratory illness 1
In Children and Adolescents
Pediatric patients experience a somewhat different side effect profile: 1
- Somnolence (feeling sleepy) 1
- Insomnia 1
- Headache 1
- Nausea and vomiting 1
- Stuffy nose 1
- Fatigue 1
- Weight gain 1
- Increased or decreased appetite 1
- Uncontrolled movements (restlessness, tremor) 1
- Increased saliva or drooling 1
- Muscle stiffness 1
Serious Side Effects Requiring Immediate Attention
Life-Threatening Conditions
Neuroleptic Malignant Syndrome (NMS) - a rare but potentially fatal condition characterized by: 1
- High fever
- Stiff muscles
- Confusion
- Sweating
- Changes in pulse, heart rate, and blood pressure
Stroke risk in elderly patients with dementia-related psychosis - aripiprazole increases death risk in this population and is not approved for this indication 1
Movement Disorders
Tardive dyskinesia - potentially irreversible uncontrolled movements affecting: 1
- Face
- Tongue
- Other body parts
- May persist even after discontinuation of aripiprazole
Extrapyramidal side effects including Parkinsonism are reported and may limit clinical use 5, 6
Metabolic and Cardiovascular Effects
Metabolic advantages compared to other antipsychotics: 2, 3
- Minimal propensity for clinically significant weight gain - aripiprazole shows favorable profile compared to other atypical antipsychotics 2, 3
- Low risk of dyslipidemia (increased cholesterol and triglycerides) 2, 3
- Minimal risk of diabetes and hyperglycemia - though monitoring is still required 1, 2
However, metabolic monitoring is still essential: 1
- Check fasting glucose before starting and at 4 weeks
- Monitor BMI, waist circumference, and blood pressure weekly for 6 weeks
- Recheck at 3 months and annually thereafter
Cardiovascular effects: 1
- Orthostatic hypotension (lightheadedness or fainting when standing)
- Tachycardia 4
- Low risk of QTc prolongation 3
Psychiatric and Behavioral Side Effects
Suicidal thoughts or actions - particularly in children, teenagers, and young adults within the first few months of treatment 1
Unusual urges and impulsive-compulsive behaviors - a notable concern with aripiprazole: 1, 7
- Problem gambling - most frequently reported 7
- Hypersexuality 7
- Compulsive eating or binge eating 1, 7
- Compulsive shopping 1, 7
- Obsessive-compulsive symptoms 7
- Trichotillomania, kleptomania 7
- Typically appear within 30 days of starting aripiprazole and resolve within 30 days of discontinuation or dose reduction 7
Severe psychiatric adverse events in children and adolescents include chronic insomnia, behavioral changes, psychoses, anxiety, and suicidal behavior 6
Hematologic and Neurologic Effects
- Low white blood cell count 1
- Seizures (convulsions) 1, 6
- Falls - due to sleepiness, dizziness, decreased blood pressure, and slowed thinking/motor skills 1
Other Serious Effects
- Hyperprolactinemia - though less common than with other antipsychotics, can occur and may require switching to aripiprazole when used as augmentation 5
- Difficulty swallowing - can cause aspiration 1
- Problems with body temperature regulation - especially with exercise or heat exposure 1
Beneficial Effects When Used as Augmentation
When aripiprazole is combined with other antipsychotics that have greater side effect burden, it can reduce: 5
- Weight gain
- Dyslipidemia
- Hyperprolactinemia
- Sexual dysfunction
Monitoring Recommendations
Essential monitoring parameters include: 5
- BMI and waist circumference weekly for 6 weeks, then at 3 months and annually
- Blood pressure weekly for 6 weeks, then at 3 months and annually
- Fasting glucose at baseline, 4 weeks, 3 months, and annually
- HbA1c, lipids, prolactin, liver function tests, urea and electrolytes, full blood count, and electrocardiogram at baseline and periodically
Clinical Considerations
Akathisia management can be approached through: 5
- Dose reduction
- Switch to quetiapine or olanzapine
- Adjunctive propranolol (10-30 mg, two to three times daily)
The overall safety profile of aripiprazole is favorable compared to other atypical antipsychotics, with minimal metabolic disruption being a key advantage 2, 3. However, clinicians must remain vigilant for movement disorders, impulsive-compulsive behaviors, and severe adverse events, particularly in vulnerable populations such as children and adolescents 6.