Aripiprazole
ABILIFY
What it isD2 and D3 partial-agonist antipsychotic with mixed serotonin effects; schizophrenia, bipolar mania and depression augmentation.
Why this oneLower prolactin, weight and sedation burden than most antipsychotics — plus long-acting options — make it a common switch.
What limits itAkathisia is the characteristic trial-ending effect. CYP2D6 and CYP3A4 modifiers change exposure; impulse-control disorders can emerge.
FDA-approved for
- schizophrenia (2002)
- bipolar mania (2004)
- adjunct for depression (2007)
- irritability in autism (2009)
- Tourette syndrome (2014)
Off-label
- Tourette syndrome
- OCD augmentation
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | adults | 10-15 mg QD | 10-15 mg QD | 30 mg QD |
| Schizophrenia | adolescents 13-17 y | 2 mg QD | 10 mg QD | 30 mg QD |
| Bipolar I mania, monotherapy | adults | 15 mg QD | 15 mg QD | 30 mg QD |
| Bipolar I mania, adjunct to lithium/valproate | adults | 10-15 mg QD | 15 mg QD | 30 mg QD |
| Bipolar I mania, monotherapy or adjunct | peds 10-17 y | 2 mg QD | 10 mg QD | 30 mg QD |
| Major depressive disorder, adjunct to antidepressants | adults | 2-5 mg QD | 5-10 mg QD | 15 mg QD |
| Irritability with autistic disorder | peds 6-17 y | 2 mg QD | 5-10 mg QD | 15 mg QD |
| Tourette's disorder | peds <50 kg | 2 mg QD | 5 mg QD | 10 mg QD |
| Tourette's disorder | peds ≥50 kg | 2 mg QD | 10 mg QD | 20 mg QD |
Titration Schizophrenia: wait ≥2 weeks between dose increases (time to steady state).
Renal Undefined
Hepatic Undefined
Instructions
- Administer once daily without regard to meals.
- Known CYP2D6 poor metabolizers: give half the usual dose.
- Adjust dose for concomitant CYP3A4/CYP2D6 inhibitors (reduce) or strong CYP3A4 inducers (increase); return to original dose when the interacting drug is stopped.
Cautions
- Elderly dementia-related psychosis: increased mortality and cerebrovascular events
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic changes: hyperglycemia/diabetes, dyslipidemia, weight gain
- Pathological gambling and other compulsive behaviors
- Orthostatic hypotension
- Leukopenia, neutropenia, agranulocytosis
- Seizures/convulsions
- Cognitive and motor impairment
- Suicidality
Adverse reactions
- Akathisia
- Extrapyramidal disorder
- Somnolence
- Tremor
- Sedation/restlessness
- Nausea
- Insomnia
- Blurred vision
Pregnancy Third-trimester exposure: risk of neonatal extrapyramidal and/or withdrawal symptoms; no established risk of major birth defects.
Lactation Present in human milk; monitor breastfed infant for dehydration and inadequate weight gain.
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$300–$5,000/dose or month
Generic entry2032 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Active metabolites
Mechanism of action: Aripiprazole ballicule
Open Aripiprazole in the interactive console ↗
Memory aids: mascots and interaction avatars
Spooky mascot → antipsychotic
Able to fly → non-sedating
