Aripiprazole (Abilify)

Basic Instructions

· Start at 2.5mg once daily

· It can be taken with or without food

· Increase by 2.5mg/day every four weeks (as tolerated) until 100% better to a maximum of 7.5mg/day.

· Common side effects tend to go away within 1-2 weeks after starting or after each dose increase, as your body adjusts to the medicine

· Typical baseline screening lab work includes:

1. CBC and Differential (repeat annually)

2. Electrolytes (repeat annually)

3. BUN, Creatinine (repeat annually)

4. Liver enzymes, bilirubin (repeat at one month and every 3 to 6 months)

5. Fasting Glucose, HbA1c (repeat at one month and every 3 to 6 months)

6. Fasting Lipid Profile (repeat every 6 months)

7. TSH, prolactin (repeat every 6 months)

8. Urinalysis

9. Baseline ECG (repeat every 6 to 12 months or more frequently in persons with cardiovascular disease)

10. BMI and Waist circumference monthly

Side effects and cautions

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Side effects of Aripiprazole/Abilify may include, among others:

· Anxiety

· belching

· blurred vision

· difficulty having a bowel movement

· dry mouth

· fear

· fever

· heartburn

· hyperventilation

· inability to sit still

· indigestion

· irritability

· lightheadedness

· need to keep moving

· nervousness

· rash

· runny nose

· shaking

· sore throat

· stomach discomfort, upset, or pain

· trouble sleeping

· weight gain

Safety concerns

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to make sure this medicine is working properly. Blood and urine tests may be needed to check for any unwanted effects.

For some patients, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or are getting worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive illness) or has tried to commit suicide.

This medicine may add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicines for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicines or narcotics, medicines for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any CNS depressants while you are taking this medicine.

Aripiprazole may cause drowsiness, trouble with thinking, or trouble with controlling movements, which may lead to falls, fractures or other injuries. Do not drive or do anything else that could be dangerous unless you know how this medicine affects you.

Check with your doctor right away if you have any of the following symptoms while using this medicine: convulsions (seizures), difficulty with breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

This medicine may cause tardive dyskinesia (a movement disorder) especially in elderly women. Check with your doctor right away if you have any of the following symptoms while taking this medicine: lip smacking or puckering, puffing of the cheeks, rapid or

worm-like movements of the tongue, uncontrolled chewing movements, or uncontrolled movements of the arms and legs.

Some people who have used this medicine had unusual changes in their behavior. Talk with your doctor right away if you start having unusual urges, such as gambling urges, binge or compulsive eating, compulsive shopping, or sexual urges while using this medicine.

Dizziness, light-headedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

This medicine may increase the amount of sugar in your blood. Also, the oral liquid form contains sugar. Check with your doctor right away if you have increased thirst or increased urination. If you have diabetes, you may notice a change in the results of your urine or blood sugar tests. If you have any questions, check with your doctor.

This medicine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

This medicine may increase your weight. Your doctor may need to check your weight on a regular basis while you are using this medicine.

Do not change the dose or stop taking this medicine without checking first with your doctor.

Serious Side Effects

Suicidal thoughts are may occur in some patients, especially children, teens, and young adults. Tell your doctor if this occurs. Other serious side effects of Abilify include:

Call your doctor at once if you have:

· severe agitation, distress, or restless feeling;

· twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;

· mask-like appearance of the face, trouble swallowing, problems with speech;

· seizure (convulsions);

· thoughts about suicide or hurting yourself;

· severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;

· low blood cell counts--fever, chills, sore throat, mouth sores, skin sores, sore throat, cough, trouble breathing, feeling light-headed; or

· high blood sugar--increased thirst, increased urination, dry mouth, fruity breath odor.

On rare occasions, exposure to atypical antipsychotics may result in a potentially life-threatening reaction known as a neuroleptic malignant syndrome (NMS). It is a condition characterized by the following symptoms:

· Altered mental state

· High fever (over 100.4 F)

· Loss of bladder control

· Muscle rigidity

· Profuse sweating

· Respiratory problem

· Seizures

· Tachycardia (rapid heartbeat)

Once symptoms appear, they tend to progress rapidly and can persist for anywhere from eight hours to over a month.

NMS is considered a medical emergency and can lead to death if left untreated. Treatment would be administered in an intensive care unit, often with mechanical ventilation, intravenous fluids, and a variety of medications used to reduce muscle rigidity, agitation, and other symptoms.

Stopping the Medication

Do not stop taking this drug abruptly as it may increase the intensity of withdrawal symptoms. Consult with your doctor before reducing or stopping this medication. You may reduce withdrawal symptoms by slowly tapering off of this medication. Possible symptoms of withdrawal include:

· Insomnia

· Irritability

· Delusions

· Hallucinations