Aripiprazole

About Aripiprazole

How aripiprazole works is unclear; the label suggests partly activating dopamine D2 and serotonin 5-HT1A receptors while blocking 5-HT2A receptors. It is labeled for schizophrenia in adults and teens 13 to 17; acute manic and mixed episodes of bipolar I disorder in adults and children 10 to 17, alone or with lithium or valproate; add-on treatment of major depressive disorder in adults; irritability with autistic disorder in children 6 to 17; and Tourette’s disorder in children 6 to 18. It is taken once a day: adults with schizophrenia or mania usually start at 10 to 15 mg, up to 30 mg; the depression add-on starts at 2 to 5 mg, up to 15 mg; and children usually start at 2 mg. Known CYP2D6 poor metabolizers, who break it down slowly, take half the usual dose.

The boxed warnings say older people with dementia-related psychosis who take antipsychotics have a higher risk of death (aripiprazole is not approved for them), and that antidepressants increased suicidal thoughts and behaviors in children, adolescents and young adults, so anyone treated for depression is watched for worsening. Other warnings cover stroke in older people with dementia, neuroleptic malignant syndrome, tardive dyskinesia, higher blood sugar, lipids and weight, low blood pressure on standing, falls, low white blood cell counts, seizures, impaired thinking and driving, overheating and trouble swallowing. Intense, uncontrollable urges to gamble, binge eat, shop or have sex can occur; the label advises considering a lower dose or stopping. In adults the most common side effect is akathisia (inner restlessness), with sedation, tremor, insomnia, constipation, tiredness or blurred vision in some uses; children most often have sleepiness, movement symptoms and tiredness.

Abilify tablets are still sold, but Abilify Discmelt disintegrating tablets, Abilify oral solution and the short-acting Abilify injection, dropped from the label in January 2025, are discontinued, as is Abilify MyCite (tablets with a sensor). Generic disintegrating tablets and solution remain, and Opipza, a film that dissolves on the tongue, was approved in July 2024 for the same uses except bipolar disorder. The solution replaces tablets milligram for milligram up to 25 mg (30 mg of tablets becomes 25 mg of solution), and disintegrating tablets can contain phenylalanine, which matters in phenylketonuria. Long-acting injections (Abilify Maintena, Abilify Asimtufii, and Aristada, which contains the related aripiprazole lauroxil) are given only by a health care professional. Babies exposed in the third trimester can have movement or withdrawal symptoms.

Taking Aripiprazole

How to take it

Once a day, with or without food. Peel back a disintegrating tablet’s foil with dry hands (do not push the tablet through) and let it dissolve on the tongue, with or without liquid. Place an Opipza film on top of the tongue without chewing or cutting it. Measure solution with an oral syringe or dosing cup.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture, out of reach of children. Keep disintegrating tablets and films sealed until use; discard solution six months after opening or at expiration, whichever is sooner.

Interactions to know about

Strong CYP2D6 blockers (fluoxetine, paroxetine, quinidine) or strong CYP3A4 blockers (itraconazole, clarithromycin) call for half the dose, and both together a quarter; carbamazepine and rifampin call for double. It adds to blood pressure medicines, and benzodiazepines add to sedation. Avoid alcohol, and take care in heat or with dehydration.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Aripiprazole differs from pharmacy to pharmacy

Generic aripiprazole tablets have many makers; disintegrating tablets and solution have fewer and are quoted only as generics. A prescription that names Abilify and blocks substitution is priced as a brand, as is Opipza.

A film, disintegrating tablet or solution cannot be swapped for regular tablets at the counter, so each quote is for the form written. Doses run from 2 to 30 mg a day, and an opened bottle of solution is discarded after six months.

Ways to pay less for Aripiprazole without insurance

• Ask for generic aripiprazole, and check that the prescription does not name Abilify only.
• If a disintegrating tablet, solution or film was chosen for ease of swallowing, ask the prescriber whether regular tablets would suit.
• If Opipza is prescribed, ask the maker whether a savings program applies to someone paying cash.
• Ask whether aripiprazole is on the pharmacy’s flat-price generic list, and ask for a ninety-day supply once the dose is settled.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Aripiprazole

1. 1.Do any of my medicines, such as fluoxetine, paroxetine, an antifungal or carbamazepine, change the dose I need?
2. 2.What should I do if I feel restless or cannot sit still?
3. 3.Which urges, such as gambling or binge eating, should I report?
4. 4.Do my disintegrating tablets contain phenylalanine?

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