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  1. 1. Names, Availability, Brand vs. Generic Issues, Forms
    1. 1.1 US brand name: Abilify
    2. 1.2 Available as Abilify in these countries1
    3. 1.3 Other trade name(s) for Abilify used in these countries1
    4. 1.4 Generic Name and Availability
    5. 1.5 aripiprazole is available in these countries2
    6. 1.6 Branded generic names3
    7. 1.7 Specific generics with complaints, or preferred generics manufacturers
    8. 1.8 Generics with independently-tested bioequivalence
    9. 1.9 Forms and Classes
  2. 2. Approved and Off-Label Uses
    1. 2.1 US FDA approved use(s)
    2. 2.2 Abilify is approved elsewhere for
    3. 2.3 Common off-label uses
    4. 2.4 Less common/experimental off-label uses
    5. 2.5 Failed off-label uses
    6. 2.6 Potentially dangerous off-label uses
    7. 2.7 When / why you should take Abilify
    8. 2.8 When / why you should not take Abilify
  3. 3. Chances of Working & Comparisons with Other Meds
    1. 3.1 How long until Abilify starts working:
    2. 3.2 Likelihood Abilify will work for its approved indications:
    3. 3.3 For off-label applications:
    4. 3.4 Abilify versus other Antipsychotics for approved treatments:
    5. 3.5 For off-label uses:
  4. 4. Dosage, Titration, and Discontinuation
    1. 4.1 Dosage and doses:
    2. 4.2 Best time / way to take Abilify:
    3. 4.3 Titration schedule:
    4. 4.4 How to discontinue Abilify:
    5. 4.5 Discontinuation symptoms:
    6. 4.6 Notes, tips, etc. about discontinuing Abilify:
  5. 5. Pros, Cons, and Interesting Information
    1. 5.1 Pros
    2. 5.2 Cons
    3. 5.3 Interesting stuff your doctor probably didn’t tell you:
  6. 6. Side Effects and Pregnancy Category
    1. 6.1 Typical side effects
    2. 6.2 Uncommon side effects
    3. 6.3 Potentially dangerous side effects:
    4. 6.4 Freaky rare side effects:
    5. 6.5 Ways to counter / minimize / mitigate / deal with some side effects
    6. 6.6 Pregnancy category

This is essentially everything we know about Abilify (aripiprazole) on two big-ass pages. On this page is brand / trade names to odds of working and comparisons with other meds, or pretty much everything most people want to know. Page two is pharmacokinetics to the bibliography, or: I’m sure somebody wants to read it.

The titles for most sections link to the pages for those sections. While all the information is on these two comprehensive pages, the individual section pages go into a little more detail about what it all means.

1.  Names, Availability, Brand vs. Generic Issues, Forms

1.1  US brand name: Abilify

Just because a drug is available in one country doesn’t mean you can get it everywhere. Even if a medication is available elsewhere, it won’t necessarily have the same brand, or trade name everywhere it is sold.

1.2  Available as Abilify in these countries1

Argentina,Australia,Canada,EU,India,Ireland,Mexico,New Zealand,UK

1.3  Other trade name(s) for Abilify used in these countries1

エビリファイ: Japan

1.4  Generic Name and Availability

A drug’s generic, or international nonproprietary name (INN) is how it is uniquely identified around the world4. The generic version of a med is are often available in other countries long before they are in the US.

Generic name/INN:aripiprazole
US Generic available?No

1.5  aripiprazole is available in these countries2

India

1.6  Branded generic names3

Arip Aripiprex Asprito aripiprazol

1.7  Specific generics with complaints, or preferred generics manufacturers

In theory the generic version of a med is the same as the brand-name version. In practice that is usually, but not always the case. Especially with crazy meds. If we know of any problems with particular generics, or if some generics are better than others, we’ll let you know.

1.8  Generics with independently-tested bioequivalence

1.9  Forms and Classes

Available/supplied as:

  • Tablets
    • 2 mg green with “A-006” and “2” imprinted
    • 5 mg blue with “A-007” and “5” imprinted
    • 10 mg pink with “A-008” and “10” imprinted
    • 15 mg yellow with “A-009” and “15” imprinted
    • 20 mg white with “A-010” and “20” imprinted
    • 30 mg pink with “A-011” and “30” imprinted
  • Orally Disintegrating Tablets
    • 10 mg pink & scattered specks with “A 640” and “10” imprinted
    • 15 mg yellow & scattered specks with “A 641” and “15” imprinted
  • Oral Solution: 1 mg/mL (3)
  • Intramuscular Injection: 9.75 mg/1.3 mL single-dose vial
  • 1% Powder (In Japan only, as far as I’ve found so far)
Primary Drug Class:Antipsychotics
Additional Drug Categories:
 MoodStabilizers, Antidepressants

2.  Approved and Off-Label Uses

Drugs are officially approved to be used for certain things, and they may be approved for one thing in one country but something else entirely in another.5

2.1  US FDA approved use(s)

  • Schizophrenia
    • Acute (4–6 weeks) schizophrenia in adults and adolescents (13–17)
    • Both the PI sheet and the FDA’s page on Abilify’s approved indications are fuzzy on Abilify being approved for maintenance (long-term, i.e. six months or longer) use.
    • It’s extra-fuzzy with adolescents, as there was only one long-term clinical trial in the US, the results were a bit sketchy, and everyone thinks it’ll work as a maintenance med for kids based upon extrapolating the data from the adult trial.
  • Bipolar I Disorder
    • Acute (adults and children 10 and up) and maintenance (adults only) treatment of manic and mixed episodes.
    • Both as monotherapy (used by itself) and as an adjunct (add-on, used with) to lithium or Depakote (or other valproate).
  • Adjunctive treatment of Major Depressive Disorder (MDD) in adults.
  • Irritability associated with Autistic Spectrum Disorder (ASD) in pediatric patients (aged 6 to 17 years) with irritability associated with autistic disorder.
  • Psychomotor agitation associated with Schizophrenia or Bipolar Mania
    • Only the intramuscular (IM) injection is approved for this.
    • “Psychomotor agitation” is defined in DSM-IV as “excessive motor activity associated with a feeling of inner tension”.
    • Which I find hilarious as this is essentially using Abilify to treat a condition that presents as (has the symptoms of) common side effects of Abilify.

2.2  Abilify is approved elsewhere for

In most places Abilify is approved only to treat bipolar disorder and schizophrenia.

2.3  Common off-label uses

Meds are often prescribed for conditions or people they aren’t approved to treat. This is known as off-label prescribing. Some off-label prescribing is so common that lots of people think the medication is a first-line treatment for the condition it’s prescribed to treat.

2.4  Less common/experimental off-label uses

When all else fails and you’ve run out of other options, the experimental use of some drug may be your best chance at treating something. Be careful! Otherwise safe meds can be downright dangerous when used for some things.

2.5  Failed off-label uses

2.6  Potentially dangerous off-label uses

2.7  When / why you should take Abilify

Just because a medication is approved or commonly prescribed for a particular condition doesn’t necessarily mean you should be taking it for that condition. There could be a drug that might be better to try first, or at least talk to your doctor about trying first, or the condition you have isn’t bad enough to warrant medication at all.

If you’ve had serious problems with other APs, like:

2.8  When / why you should not take Abilify

  • Just thinking about certain foods or certain meds (like Strattera or Depakote) makes you need to take anything in the PeptoBismal to Prilosec spectrum.
  • If you’re already diagnosed with GERD, or something similar, Abilify is in the last resort category.
  • You emptied your bank account at the nearest casino when you took Requip (ropinirole) or Mirapex (pramipexole).

3.  Chances of Working & Comparisons with Other Meds

Two of the most important things to know when deciding on which med is the best for a particular condition7: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Unfortunately because no one is quite sure exactly what causes various conditions - further complicated when everything is a spectrum disorder - and they’re never really sure about how a med works in the first place, especially when there are lots of contradictory and/or questionable studies,8 we can only give you an idea somewhat less vague than support groups and PI sheets, but certainly more accurate than the implied “it fixes everything all the time!” promises of pharmaceutical advertising.
See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

3.1  How long until Abilify starts working:

Faster than Seroquel, but slower than most other AAPs. I.e. 3–7 days, with 3 days more likely when adding Abilify to an AD and 7 days more likely when using Abilify by itself.

3.2  Likelihood Abilify will work for its approved indications:

Given its activating nature, Abilify is probably more likely to work as an add-on to treat depression or bipolar disorder than as monotherapy for bipolar disorder.

3.3  For off-label applications:

3.4  Abilify versus other Antipsychotics for approved treatments:

For Bipolar disorder:

  • Abilify vs. Haldol (haloperidol) vs. Placebo for bipolar mania. This is one of the European clinical trials, so it was paid for by Bristol-Myers Squibb (BMS) and Otsuka Pharmaceuticals, the manufacturers of Abilify. Haldol? OK, they were looking only at mania, so Haldol qualifies as an active placebo. The results: A tie! Wait, what? Yup, Haldol was marginally more effective, but Abilify sucked somewhat less.

For Schizophrenia

  • Abilify vs. Risperdal vs. Placebo for schizophrenia & schizoaffective disorders. This is another BMS & Otsuka-sponsored study, so you know Abilify is going to win. The results: A tie! Even with one hand tied behind its back, Risperdal was just as good as Abilify. Abilify was better for negative symptoms and Risperdal was better for positive symptoms. Abilify sucked a lot less for the big-ticket side effects of weight gain, hyperprolactinemia-associated adverse reactions (porno boobs, leaky tits, sexual dysfunction, etc.), and QT interval, but Risperdal is easier to keep down. Oddly enough movement disorders were identical, but this was high-dosage Abilify (20–30mg) vs. low target dosage (for schizophrenia) (6mg) Risperdal.
  • Abiliby vs. Risperdal or Seroquel or Zyprexa: which makes you less crazy while still letting you fuck like a crazed otter? This is an expanded look at the data from one of the European clinical trials, so it’s BMS & Otsuka-sponsored study, and you have to expect Abilify going to win. They just lumped the competition into one group, so there’s no way to tell how each of the other meds worked. The results: Abilify worked better and sucked a lot less, especially when it came to sex. Why am I not surprised?
  • Abilify vs. Zyprexa which one works better and sucks less when treating schizophrenia. This is an Eli Lily-sponsored clinical trial that taught me the official research name of which sucks less: “all cause discontinuation.” The results: In spite of the weight gain Zyprexa wins. Anyone surprised? That Zyprexa works better and faster is to be expected, even in a trial run by a neutral party, but when Abilify has an affect on weight, glucose, and triglycerides that make it look like a diabetes treatment, you’ve got to wonder about why so many people dropped it.

3.5  For off-label uses:

4.  Dosage, Titration, and Discontinuation

One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.
We here at Crazy Meds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage9. More and more doctors are agreeing with us10. You and your doctor can always discuss increasing the dosage when you need to in advance.

4.1  Dosage and doses:

As with many APs, BMS recommends you just start at the target dosage. That’s 10–15mg a day for Schizophrenia, 15mg a day for bipolar (as monotherapy), and 10–15mg a day for bipolar (when taken with Depakote or lithium). The maximum dosage is 30mg a day, and you should wait at least two weeks before increasing the dosage.
The only application where you start at a low dosage a move up is when you add it to an AD for depression. That’s when they recommend you start at 2–5mg a day, work up to 5–10mg a day, and the maximum dosage is 15mg a day, and you should wait at least a week before increasing the dosage.

4.2  Best time / way to take Abilify:

4.3  Titration schedule:

4.4  How to discontinue Abilify:

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others it can be a nightmare.
With its long-ass half-lives, a lot easier than most meds.

4.5  Discontinuation symptoms:

4.6  Notes, tips, etc. about discontinuing Abilify:

5.  Pros, Cons, and Interesting Information

Every med has its good points and its bad points. This is what we think those are.
Doctors don’t have the time to tell you everything about a drug. Patient information leaflets leave out a lot. Even if the PI sheet covers everything the language is so dense and obtuse that the good stuff is often lost in information overload. Most meds have something interesting about them.

5.1  Pros

As it sort of acts as a Parkinson’s/RLS med, so you’re somewhat less likely to get a couple of the more annoying AP side effects - most movement disorders and those involving prolactin.
The anticholinergic side effects are also less likely than other APs.
The long half-lives of of Abilify and its active metabolite mean you don’t have to worry about a dosing schedule, and you can even take a tablet every other day.

5.2  Cons

Since it kind of acts like a Parkinson’s/RLS med, you can get the oddball side effects of a Parkinson’s/RLS med, like pathological gambling. It also means you can’t take another dopamine agonist to deal with movement disorders and need to take a potent anticholinergic like Cogentin.
Abilify’s long-ass half-lives mean if you two don’t get along you can be stuck with the side effects for at least one, and possibly two weeks after you stop taking it.

5.3  Interesting stuff your doctor probably didn’t tell you:

Abilify is the first third-generation antipsychotic (TGA) to hit the US market. TGAs are defined as being partial agonists at dopamine D2 receptors, and that’s what makes them act sort of like Parkinson’s/RLS meds. So, unlike Zyprexa, Abilify doesn’t just mask movement disorders by being a potent anticholinergic, it tries to prevent them from happening in the first place.

6.  Side Effects and Pregnancy Category

Potential side effects are used as a rationalization to not take a medication. Many people will stop taking an otherwise working drug because of one or more relatively minor, or often temporary side effects. There may even be ways to counter or mitigate side effects.
It all comes down to a very important question: which sucks less?
No matter what crazy med you take, it will probably make you feel spacey and generally out of it for the first few days (i.e. don’t operate heavy machinery), as well as make you drowsy. Even stimulants can make you drowsy. Abilify will probably affect your dreams as well, and there’s no way to tell if that will be a temporary or permanent side effect. Don’t be surprised if your stomach and/or other parts of your GI system complain for at least the first few days.

6.1  Typical side effects

Most everyone gets at least one or two of these.
Headache. Agitation, akathisia (the inability to sit still), anxiety, insomnia, restlessness; unlike almost all other APs, Abilify is more likely to make you hyper instead of turning you into a zombie.
The Abilify Burp - a type of mild-to-moderate gastric reflux. You’ll know it when you taste it. Abilify so many GI-related side effects that you might as well be taking valproic acid or felbamate.
These side effects are in the “Usually temporary, but they’ll flare up, especially when you change your dosage” category.

6.2  Uncommon side effects

You may or may not get one or more of these.
Blurred vision, mania (regardless of your being bipolar or not), teeth grinding & jaw clenching (but rarely progressing to TMJ like Lexapro), muscle aches, orthostatic hypotension (getting dizzy, feeling faint and nearly-to-actually passing out when you stand up).
Unlike most APs, Parkinson’s-like movement disorders (EPS & TD) are uncommon. They can still happen, but they’re just a lot less likely. The same applies to weight gain. Abilify can still hose your blood sugar, though.

6.3  Potentially dangerous side effects:

If you have these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER. NOW!

6.4  Freaky rare side effects:

You won’t get these. Unless you already have and that’s why you’re here.
Rabbit syndrome. Bone pain. Waxing-and-waning catatonia.

6.5  Ways to counter / minimize / mitigate / deal with some side effects

6.6  Pregnancy category

 Expanded pregnancy category explanation.

‹ Bibliography | Abilify Index | Comprehensive Rundown Page 2 ›

1 EU: European Union. Currently Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. Not all drugs approved in any one EU country are approved in all, but most crazy meds approved in several EU countries are at least obtainable in all EU countries on the European mainland. I'm not sure about Britain, Cyprus, Ireland, and Malta.
The UK and Ireland are listed separately because we're a primarily English-language site. Plus the UK tends to be more independent on more matters than any other EU member state, so it should probably be listed separately no matter what language a site like this is in.
While the EU is moving toward one brand name for the same med, that's not going to happen overnight. And people will still refer to meds by old brand names. So we'll list old brand names until they vanish.

2 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

3 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin**, and they are owned by Pfizer***, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

4 Except in Finland, where generic names are sometimes rendered into Finnish. This may happen elsewhere, but I haven't come across anyone else doing it.

5 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

6 I guess it was sheer luck that not a single person with whom I shared time in the lock ward during my timeout from polite society complained of invisible spiders. So, how many of the people complaining about beg buds in NYC are nutjobs? And how many of the mentally interesting who live on the streets have real lice and other critters living on them?

7 Assuming you were correctly diagnosed in the first place.

8 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.***** That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science******* and Why Most Published Research Findings Are False********. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.********

9 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

10 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy****, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.


Date created Tuesday, 29 November 2011 at 11:57:45 Page Creator: Jerod Poore Last edited by:

Crazy Meds’ Comprehensive Pages on Abilify is copyright 2011 Jerod Poore


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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]


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