Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Aripiprazole is a leading prescription schizophrenia drug. The brand name for this drug is Abilify, and as we outlined in our Abilify reviews article, these two terms refer to the same active drug ingredient. Thus, we will refer to them interchangeably throughout this article.
In this article we’ll examine published medical studies on aripiprazole to determine if the drug is safe and effective for treating schizophrenia. We’ll highlight its side effect profile, explain whether the branded version is more effective, and explain whether the injectable or capsule versions differ in terms of efficacy.
Does Aripiprazole Work?
Aripiprazole has been studied for the treatment of a number of mental health conditions, including schizophrenia, mania, and bipolar disorder (BPD). The medication is approved by the Food and Drug Administration (FDA) in the U.S. for treatment of all three listed conditions.
A 2010 medical study examined the efficacy of aripiprazole for treating schizophrenia. Researchers examined 11 clinical trials on the topic.
What the researchers found was that aripiprazole is an effective monotherapy for schizophrenia in both short-term and long-term trials. Monotherapy is the medical term for a drug that can successfully treat a condition alone. This is an important finding, because schizophrenic patients are often prescribed multiple prescription drugs to treat their condition. If one drug alone is effective, it can reduce cost and compliance issues.
One of the included trials had a 52 week duration, and schizophrenia symptoms were controlled throughout. Aripiprazole was even found to successfully manage treatment-resistant schizophrenia, which is defined as schizophrenia that did not respond to multiple other drugs.
Another medical review, published in the Cochrane Database of Systematic Reviews journal, analyzed how effective aripiprazole was for treating patients with mania. Ten clinical trials on the topic were included in the review.
Aripiprazole was documented to be efficacious for reducing mania symptoms short-term (3 and 4 weeks from the start of the trial) but not long-term (6 weeks from the start of the trial). The drug was equally effective to two other commonly-prescribed mania medications; lithium and haloperidol.
Aripiprazole is definitely effective for mania, or else it wouldn’t have been approved by the FDA, but it seems in our opinion that its clinical backing is weaker than for treating schizophrenia.
A meta-study on aripiprazole for bipolar disorder analyzed data from 20 clinical trials on the topic.
The study authors found that aripiprazole could successfully treat some characteristics of BPD (acute mania, psychosis) but not others (depressive symptoms). It was concluded to be effective overall because it improved patients’ quality of life when compared to placebo.
We will conclude based on the available research that aripiprazole is effective for treating schizophrenia, BPD and mania. In our opinion, the clinical backing for its efficacy in treating schizophrenia is by far the most robust, given that the drug was effective in both short-term and long-term trials, and seemed to successfully reduce all clinical manifestations of the condition.
Aripiprazole improved symptoms on average and patient quality of life in trials for mania and BPD, but the drug appears to have some limitations for treating those conditions.
How Does Aripiprazole Work?
Aripiprazole’s mechanism of action is to normalize dopamine and serotonin levels in various regions of the brain according to StatPearls, which is one of the largest free medical databases in the U.S., and is maintained by the National Library of Medicine. These two neurotransmitters play a direct role in mood stabilization and emotional regulation, and it’s theorized that their metabolism is dysregulated in patients with mental conditions like schizophrenia.
To get more technical, aripiprazole is a D2 and 5HT-1a receptor agonist, and an antagonist at the 5HT-2a receptor. An agonist activates receptors in the brain to produce a biological response, while antagonists do the opposite: they bind to receptors and reduce their response.
Researchers don’t yet understand exactly how these agonist and antagonist actions can positively affect schizophrenic patients, as this mental condition is quite complex and multifactorial. As more research emerges, it’s likely the medical community will better understand how to target therapies better for patients with schizophrenia and BPD.
Aripiprazole Side Effects
Aripiprazole does cause side effects in some patients, as is common for prescription medications which treat mental health conditions.
According to a medical review published in the Expert Opinion on Pharmacotherapy journal, the most common side effects of aripiprazole are restlessness, drowsiness and nausea.
The FDA also published a warning letter in 2016 highlighting how the drug causes impulse-control problems in some patients. The FDA published this warning because their stance was that the notice on the drug’s label about gambling risk wasn’t comprehensive enough, and that compulsive eating, shopping and sexual habits were also a risk.
Aripiprazole’s FDA label has a “black box” warning which explains how the drug may increase suicidality. This is the most severe level of warning issued by the FDA, and indicates a side effect that may be life-threatening. This side effect isn’t likely to be experienced by the average patient, but even if it’s rare, it’s still concerning in our opinion.
Clearly aripiprazole may cause a wide range of relatively severe side effects, and we’d recommend that patients speak with their doctor about this side effect profile prior to treatment. There may be schizophrenia medications available without such a severe side effect profile. This side effect profile is one of the most concerning of any prescription medication we’ve reviewed on Illuminate Health to date.
Should I Take the Brand Name Version?
As we referenced earlier in this article, the brand name version of aripiprazole is Abilify. Patients are often curious about whether the branded version is more effective than the generic. Because brand name and generic drugs contain the same active chemical compound, they should be similarly effective.
A 2019 medical review comparing the efficacy of branded and generic drugs confirmed this. On average, the two categories of medication were equally effective. There were a few exceptions, but Abilify was not one of them.
We would recommend that patients speak with their doctor about aripiprazole rather than Abilify, as generic versions of drugs are often significantly cheaper. Since it’s likely to be as effective, it seems logical to go with the generic option.
As documented in the previously-linked StatPearls resource, the effective daily dosing range for oral formulations of aripiprazole is 5 milligrams (mg) to 30 mg. The drug comes in capsules of 2 mg, 5 mg, 10 mg, 15 mg, 20 mg and 30 mg.
Intramuscular aripiprazole dosage ranges from 441 mg to 1,064 mg, and is administered every 4 to 6 weeks.
The dose used for treating schizophrenia and BPD tends to start at 10 or 15 mg and work up to 30 mg, while a lower dose of 2-5 mg is often prescribed for aripiprazole as an adjunctive treatment. This refers to when the drug is a secondary treatment and a patient is already taking a separate pharmaceutical medication as their main treatment.
It’s important that patients work closely with their doctor if they choose to increase the dosage, because doing so can increase the risk of side effects. It’s not safe or recommended for patients to increase the dosage of their prescribed medication without physician guidance.
Does Aripiprazole Cause Weight Gain?
Patients are often curious if aripiprazole causes weight gain, because many prescription medications for mental health conditions do. Thankfully, this potential side effect has been studied extensively in medical literature.
One medical review from 2018 examined patient data from over 25,000 patients that had taken the drug at least once, and found that its use was associated with weight gain on average. Patients taking aripiprazole as a standalone treatment gained an average of 3.4% body weight over the course of 180 days. This equates to weight gain of 6.8 pounds (lbs) for a 200 lb adult.
This medical review does not prove that aripiprazole caused the weight gain, just that there was an association. There was no control group in this study, so it’s impossible for researchers to definitively say that aripiprazole was the cause of the weight gain using this data.
Another meta-study analyzed the risk of weight gain and metabolic disorder from aripiprazole use with that from other antipsychotic medications. The study authors found that aripiprazole was associated with moderate weight gain in clinical trials, but that it caused less weight gain than other drugs in the same class.
Clinical research suggests that aripiprazole may cause weight gain. The causality hasn’t been definitively proven, but the drug is associated with weight gain when examining real-world patient data.
Many prescription antipsychotic medications are associated with weight gain, but this data suggests that overweight and obese patients may benefit from asking their doctor about alternate medications which aren’t associated with increased weight in medical studies.
Aripiprazole User Reviews
Aripiprazole has been reviewed over 1,000 times on Drugs.com, which is a website where users of prescription medications can submit personal reviews of their experience on the drug. We cannot verify the accuracy or authenticity of any reviews of this site.
Aripiprazole has a 5.8/10 average rating for treating schizophrenia, a 5.7/10 average rating for treating BPD and a 6.4/10 rating for treating depression.
The top positive review of aripiprazole for schizophrenia is written by a user named “justin” who claims the drug eliminated the intrusive thoughts they were experiencing:
“I've been on [aripiprazole] for about five days. And I noticed a big change. I'm not having any intrusive/destruction thoughts. I'm not hearing voices. Even my dreams have gotten better. So, I WOULD DEF RECOMMEND!”
The top negative review of aripiprazole for schizophrenia comes from a user named “Rose” who claims the medication caused an unpleasant mood:
“[Aripiprazole] wasted a year of my life. I had to abuse stimulants (which made my symptoms worse) to function. My hallucinations were semi controlled but I still heavily struggled with delusions. I thought it was the best I could get but no. After trying many more I found an antipsychotic that doesn't make me a robot.”
Should I Take Aripiprazole in the Morning?
While only a doctor can recommend medication timing to an individual patient, there is some interesting research on the optimal timing of daily aripiprazole use.
A medical review published in the well-respected Frontiers in Psychiatry journal examined whether the timing of aripiprazole administration could affect metabolic risk. The researchers compared data on patients who took the drug in the morning and those who took the drug in the evening.
Patients taking aripiprazole in the evening had unfavorable effects on their cholesterol levels compared with those taking the drug in the morning. It’s not exactly clear why this occurred, but the study authors proposed that taking aripiprazole at night may increase overnight insulin release, which has negative downstream effects on cholesterol.
It may be worthwhile for patients to share this study with their doctor and discuss taking aripiprazole in the morning.
Injectable Vs. Oral Aripiprazole
Aripiprazole is prescribed in multiple formats: oral (tablets) and an intramuscular (IM) injectable form. The IM version of aripiprazole is a branded drug called “Abilify Maintena.”
The core benefit of the IM version of the drug is that it’s longer-acting. A medical study comparing oral versus injectable aripiprazole found the two dosing formats to be equally effective, but that the injectable form had a longer duration.
Intramuscular injections have their own risk profile independent from the drug used, so we recommend that patients talk with their doctor about taking the oral version of aripiprazole unless there is a strong reason to take intramuscular instead.