Abilify

Forms/Strengths

Age: >6 y/o
- Irritability Associated with Autistic Disorder: 6-17 years
- Bipolar I Disorder (Acute Mania/Mixed): 10-17 years, adults
- Schizophrenia: 13+ years, adults
- Tourette’s Disorder: 6-17 years
Duration: ~75 hours (half-life)
Considerations: Monitor for EPS, metabolic and cardiovascular changes, assess behavioral shifts (especially in ADHD/mood dysregulation), and counsel families on potential side effects and gradual titration.
Initial Dose:
- Autism: 2 mg/day
- Bipolar: 2-5 mg/day (pediatrics), 10-15 mg/day (adults)
- Schizophrenia: 2 mg/day titrated to 10-15 mg/day
- Tourette’s: 2 mg/day
Titration: Increase dose every 1–2 weeks
Max Dose:

Indication Pediatric Max Dose Adult Max Dose

Autism 15 mg/day N/A

Bipolar I 30 mg/day 30 mg/day

Schizophrenia 30 mg/day 30 mg/day

Tourette’s 20 mg/day (6-12 y/o), 30 mg (13-17 y/o) N/A

Partial agonist at dopamine D2 & serotonin 5-HT1A; antagonist at 5-HT2A receptors
Modulates neurotransmission to stabilize mood and reduce psychotic symptoms
Approved for reducing irritability and tantrums in children with autistic disorder
Effective as adjunctive therapy in major depressive disorder
Useful in controlling manic symptoms in bipolar I disorder and reducing motor/vocal tics in Tourette’s Disorder
Off-label benefits include use in ADHD-related aggression, disruptive behavior, and impulsivity
Side effects: akathisia, restlessness, insomnia, nausea, potential metabolic changes
Lower risk of extrapyramidal symptoms (EPS) compared to first-generation antipsychotics.
Less metabolic side effect burden than other second-generation antipsychotics like olanzapine or clozapine.
Use with caution in patients with cardiovascular/metabolic risks

Irritability Associated with Autistic Disorder (ICD-10: F84.0): Reduces aggression and tantrums.
Major Depressive Disorder, Adjunctive Use (ICD-10: F32.9 / F33.9): Enhances antidepressant effects.
Schizophrenia (ICD-10: F20.x): Reduces delusions and hallucinations.
Bipolar I Disorder (ICD-10: F31.x): Controls manic episodes and stabilizes mood.
Tourette’s Disorder (ICD-10: F95.2): Reduces motor and vocal tics.

Generalized Anxiety Disorder (ICD-10: F41.1): Sometimes used adjunctively in refractory cases
Post-Traumatic Stress Disorder (ICD-10: F43.10): May benefit select patients not responding to first-line treatments
Borderline Personality Disorder (ICD-10: F60.3): May help reduce impulsivity and emotional dysregulation
Behavioral Control in ADHD/Disruptive Behavior: Although not FDA-approved for this use, aripiprazole is often considered in pediatric patients with significant aggression or impulsivity when first-line ADHD treatments are insufficient

Administration:
- Can be taken with or without food
- Orally Disintegrating Tablets (ODT): Place on the tongue and allow to dissolve; do not chew or crush
- Oral Solution: Measure accurately with a dosing syringe or cup
- Take at the same time each day for consistency in drug levels
Missed Dose:
- Take as soon as possible unless it is near the next scheduled dose; do not double up
Discontinuation:
- Taper gradually when discontinuing to avoid withdrawal effects or rebound behavioral symptoms

Metabolic Effects: Monitor weight, fasting glucose, and lipid profiles regularly.
Psychiatric Symptoms: Watch for worsening mood, suicidal thoughts, or unusual behavior.
Tardive Dyskinesia: Assess for abnormal involuntary movements periodically.
Blood Pressure: Monitor for orthostatic changes, especially in older adults.
Baseline and Routine Monitoring:
- Fasting glucose and lipid profile.
- CBC (if history of leukopenia/neutropenia).
Others: Monitor prolactin if symptoms of hyperprolactinemia occur.

When to Call the Doctor:
- Signs of allergic reaction (rash, swelling, difficulty breathing).
- High fever, muscle stiffness, or confusion (possible Neuroleptic Malignant Syndrome).
- Uncontrolled movements of face, tongue, arms, or legs (possible Tardive Dyskinesia).
- Sudden mood changes, agitation, suicidal thoughts.
- Severe dizziness or fainting.
- Excessive thirst, frequent urination, unexplained weight loss (possible hyperglycemia).
Safety Tips:
- Avoid alcohol and CNS depressants, as they may enhance sedation.
- Caution with activities requiring alertness (e.g., driving) until individual response is known.
- Slow positional changes to prevent orthostatic hypotension.
- Maintain hydration and monitor for heat intolerance.
- Tapering may be necessary before discontinuation to prevent withdrawal effects.
Parent Tips for Pediatric Patients:
- Monitor for behavioral changes (e.g., aggression, restlessness, suicidal ideation).
- Encourage nutrient-dense meals to counteract potential weight gain.
- Watch for sedation-related school performance issues.
- Communicate with teachers and caregivers regarding behavioral or academic changes.
- Ensure adherence; skipping doses may reduce symptom control.

Contraindications:
- Hypersensitivity to aripiprazole or any component of the formulation.
Pregnancy: Use only if benefits outweigh risks; limited data available (Category C).
Lactation: Excreted in breast milk; not recommended.
Drug Interactions:
- CYP3A4 and CYP2D6 inhibitors (e.g., fluoxetine, ketoconazole) may increase aripiprazole levels.
- CYP3A4 inducers (e.g., carbamazepine, rifampin) may decrease efficacy.
- May potentiate effects of antihypertensives, leading to hypotension.
- Caution with dopamine agonists or antagonists due to possible pharmacodynamic interactions.