Aripiprazole (Abilify): Uses, Dosage, Side Effects, and What to Expect

Aripiprazole (brand name: Abilify) is a atypical antipsychotic (partial dopamine agonist). Aripiprazole has a unique mechanism among antipsychotics — it is a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, and an antagonist at 5-HT2A receptors. As a partial D2 agonist, it stabilizes dopamine signaling: reducing activity where dopamine is excessive (mesolimbic pathway — treating psychosis) while maintaining or enhancing activity where dopamine is deficient (mesocortical and nigrostriatal pathways — potentially fewer cognitive and movement side effects).

• Schizophrenia
• Bipolar I Disorder (acute manic/mixed episodes, maintenance)
• Major Depressive Disorder (adjunctive)
• Irritability associated with Autism Spectrum Disorder
• Tourette's Disorder

Common off-label uses:

• Generalized Anxiety Disorder
• PTSD
• Borderline Personality Disorder
• Bipolar Depression (limited evidence)

Schizophrenia: 10-15 mg/day, max 30 mg. Bipolar mania: 15-30 mg/day. Adjunctive MDD: 2-5 mg/day (start low, max 15 mg). Autism irritability: 5-15 mg/day. Long-acting injectable (Abilify Maintena): 400 mg monthly. Oral solution and orally disintegrating tablets available.

Antipsychotic effects begin within 1-2 weeks. Full efficacy for schizophrenia: 4-6 weeks. Adjunctive antidepressant effects: 1-2 weeks.

• Akathisia (restlessness — the most common and distressing side effect, ~10-25%)
• Insomnia
• Nausea
• Headache
• Weight gain (less than quetiapine or olanzapine, but still possible)
• Constipation
• Anxiety or agitation (especially early in treatment)

• Compulsive behaviors (gambling, shopping, binge eating, hypersexuality — FDA warning added 2016)
• Tardive dyskinesia
• Neuroleptic malignant syndrome
• Metabolic effects (generally milder than other atypicals)
• Orthostatic hypotension
• Increased mortality in elderly with dementia (black box warning)

CYP2D6 and CYP3A4 substrate. Strong CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine) or CYP3A4 inhibitors (ketoconazole) increase levels — reduce dose by 50%. CYP3A4 inducers (carbamazepine) decrease levels — double the dose.

FDA Pregnancy Category C. Third-trimester exposure may cause extrapyramidal symptoms in newborns.

Can generally be tapered over 1-2 weeks. Rebound psychosis is possible in schizophrenia if stopped abruptly.