Abilify, the brand name for aripiprazole, is an antipsychotic used for schizophrenia, bipolar disorder, and as an add-on for depression. Beyond the usual side effects, it carries an unusual and under-recognised warning: the FDA cautioned in 2016 that it can cause compulsive urges to gamble, shop, eat, or have sex, which often go unnoticed and typically stop when the dose is lowered. It also has two boxed warnings. Here is what to know, which does not replace your prescriber’s or pharmacist’s advice.
What Abilify Is and Treats
Aripiprazole is a second-generation, or atypical, antipsychotic that works differently from most by partially activating dopamine receptors. It is FDA-approved for schizophrenia, bipolar I disorder, as an add-on treatment for major depression, for irritability associated with autism, and for Tourette disorder. Long-acting injectable versions exist for maintenance treatment.
Common Side Effects
The most common is akathisia, a distressing sense of inner restlessness and inability to sit still. Others include nausea, vomiting, constipation, headache, dizziness, difficulty sleeping or drowsiness, anxiety, tremor, blurred vision, and weight gain.
The Impulse-Control Warning
This is the effect most worth knowing about, because people often do not connect it to the medication.
In 2016 the FDA warned that aripiprazole can cause compulsive, hard-to-control urges, most often gambling, but also binge eating, compulsive shopping, and compulsive sexual behaviour. These urges typically appeared after starting the drug and stopped when the dose was reduced or the medication was discontinued.
Because someone experiencing this rarely links it to a pill, families should know to watch for it. If new compulsive behaviour appears, it should be reported to the prescriber rather than ignored.
Serious Side Effects and When to Seek Help
Neuroleptic malignant syndrome, a rare emergency with high fever, muscle rigidity, and altered mental state.
Tardive dyskinesia, involuntary repetitive movements often of the face and mouth, which can become permanent, so report any abnormal movements early.
Metabolic changes, including high blood sugar or new diabetes, raised cholesterol, and weight gain, which is why weight, glucose, and lipids are monitored during treatment.
Also seek help for fainting or dizziness on standing, seizures, difficulty regulating body temperature, trouble swallowing, and signs of a low white blood cell count such as fever and infections.
The Two Boxed Warnings
Aripiprazole carries the FDA’s strongest warning on two counts.
First, an increased risk of death in elderly people with dementia-related psychosis. It is not approved for that use.
Second, the antidepressant class warning about increased suicidal thoughts and behaviour in people under 25, relevant because it is used as an add-on for depression. If you are having thoughts of self-harm, call or text 988 in the US.
Key Interactions
Aripiprazole is processed by two liver enzymes, so its level swings with other drugs. Strong inhibitors such as the antifungal ketoconazole or the antidepressants fluoxetine and paroxetine raise its level, often requiring a lower dose. Strong inducers such as carbamazepine and rifampin lower it. It also adds to the sedation and blood-pressure-lowering effects of alcohol, sedatives, and blood pressure medicines. Give your pharmacist your full list.
Stopping Abilify
Stopping abruptly can cause withdrawal movements and a return of symptoms, so changes should be supervised and usually tapered. Aripiprazole also has a long half-life of around three days, so dose changes take days to weeks to show their full effect, which is worth knowing when judging how you feel after a change.
What a Pharmacist Would Emphasise
Tell patients and families to report any new compulsive urges, since these are often missed and reversible. Attend the periodic checks of weight, blood sugar, and cholesterol. And report any unusual involuntary movements promptly, as early recognition of tardive dyskinesia matters.
Abilify FAQs
What are the most common side effects of Abilify?
Restlessness known as akathisia is the most characteristic, along with nausea, constipation, headache, sleep changes, anxiety, tremor, and weight gain.
Can Abilify cause gambling or other compulsive behaviour?
Yes. The FDA warned in 2016 that it can cause compulsive urges to gamble, eat, shop, or have sex. These often go unnoticed and typically stop when the dose is lowered or the drug is stopped, so they should be reported.
Why does Abilify have boxed warnings?
Two of them: an increased risk of death in elderly people with dementia-related psychosis, and the antidepressant class warning about suicidal thoughts in people under 25.
Does Abilify cause weight gain and diabetes?
It can cause weight gain and metabolic changes including high blood sugar and raised cholesterol, which is why these are monitored during treatment, though it tends to have less metabolic effect than some other antipsychotics.
Can I stop Abilify suddenly?
No. Stopping abruptly can cause withdrawal movements and symptom relapse. Because of its long half-life, changes also take days to weeks to show fully. Any change should be supervised.
What is tardive dyskinesia?
Involuntary repetitive movements, often of the face and mouth, that can become permanent. Report any abnormal movements to your prescriber early.
