Aripiprazole | Atypical Antipsychotic Side Effects

Medication name

Aripiprazole ("arry-PIP-ra-zole")
Brand name

Abilify® ("a-BIL-if-eye")
Medication type

Second generation antipsychotic (sometimes referred to as an ‘atypical antipsychotic')

Tablets: 5mg, 10mg, 15mg, 30mg strengths

Orodispersible (‘melt in your mouth’) tablets: 10mg, 15mg and 30mg strengths

Liquids: 1mg per ml (one 5ml spoonful is like a 5mg tablet)

Abilify Maintena™ comes in four strengths: 300mg, 400mg, 720mg and 960mg. This is a long acting intra-muscular injection that is administered once a month (300mg and 400mg dose) or once every 2 months (720mg and 920mg dose) instead of taking tablets or liquid every day.

There is a short acting injection too. This would only ever be prescribed if you were in hospital, for short-term use only.

If you are 13 or over, aripiprazole can be prescribed as a licensed medicine to treat manic episodes in bipolar disorder. In some cases it may be continued to prevent the recurrence of mania.

If you are 15 or over, the doctor can prescribe aripiprazole for you as a licensed medicine for schizophrenia.

The long-acting injection, Abilify Maintena™, is licensed for people aged 18 years and older. If you are younger than the ages listed above, a specialist doctor may still consider this as a treatment option.

A specialist may discuss this as an option to manage tics in Tourette’s syndrome, severe anxiety, depression in combination with other antidepressant medication or to manage severe irritability, agitation or feelings of anger.

Read our guide to mania and hypomania

About aripiprazole

Aripiprazole is a second-generation antipsychotic (sometimes described as an ‘atypical antipsychotic’). It may also be described as a ‘mood stabiliser’ or a ‘dopamine stabiliser’.

Dopamine and serotonin are naturally occurring chemical messengers (or 'neurotransmitters') in the brain, which are mainly involved in mood, thinking, emotions, behaviour and perception.

Research suggests that mania and psychosis are more likely to occur when parts of the brain have too much of the chemical dopamine. Aripiprazole reduces dopamine activity where it is too high, helping with symptoms like hallucinations. It also increases dopamine activity in areas of the brain where it is low, helping with symptoms like poor motivation.

It also targets serotonin receptors to help regulate the release of dopamine in specific parts of the brain, which can help to reduce side effects like movement disorders. This can also help with symptoms of depression and anxiety.

Aripiprazole and everyday life

It can take a few days, or sometimes a few weeks, for aripiprazole to start helping you. You may not feel the full effects of the medication for four to six weeks, sometimes longer. It’s hard to be exact because aripiprazole works differently for each person.

If you have seen no change in any symptoms after two weeks, you should talk to your doctor about your progress. They may recommend increasing the dose or changing your medicine. Don’t increase your dose yourself if you think the medication isn’t working.

If you are starting on the long-acting injection (Abilify Maintena™), it can take a few days for the first injection to start working.

If you switch from aripiprazole tablets to the injection, you may need to continue taking your tablets for the first few weeks after your first injection, as the injection takes a few weeks to kick in. Your doctor will advise you on this.

Aripiprazole can cause both weight gain and weight loss, but it has a lower risk of weight gain compared to other antipsychotics.

Children and young people are more prone to this side effect than adults. But it's hard to predict how the medication will affect each person, so if you notice any changes in your weight while taking aripiprazole, consult your doctor or pharmacist.

Sometimes, aripiprazole is prescribed alongside other antipsychotics to manage symptoms and counteract weight gain caused by those medications. Your doctor should regularly monitor your weight while you are on aripiprazole.

Children and adolescents naturally gain some weight as they grow, but any significant weight increase should be carefully monitored. Mental health conditions like schizophrenia and bipolar disorder can make it harder to stay active and eat healthily, so it's important to seek advice from your doctor, pharmacist, or specialist healthcare team for lifestyle support.

Most weight gain, if it occurs, usually happens within the first six months of treatment, although it may continue at a slower rate afterwards, even with a low dose. People new to this type of medication may be more likely to gain weight, but it's impossible to predict how aripiprazole will affect someone before they start taking it.

Aripiprazole can also affect how your body processes sugar, leading to high blood sugar levels. While this is uncommon, it can contribute to the development or worsening of diabetes, particularly in young people, and may be associated with weight gain.

Be alert for symptoms that suggest your body is struggling to process sugar, like excessive thirst, frequent urination, or persistent fatigue. If you experience these symptoms or have other concerns, schedule an appointment with your doctor.

If you already have diabetes, aripiprazole may impact your blood sugar levels. Discuss this with your doctor, monitor your blood glucose regularly, and you may need to adjust your diabetes medication accordingly.

You may want to let your family and friends know you are taking aripiprazole so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Aripiprazole may make you feel very sleepy but may also make it hard to get to sleep.

Sleepiness has been shown to affect young people more than adults.

See how it affects you for the first few days of taking it.

Unless the medication makes you feel sleepy, it is best to take it at about the same time of day in the morning. Taking it in the evening can make it harder to get to sleep.

If you have been taking aripiprazole for more than a month and you continue to feel very sleepy during the day or your sleep at night is worse, you should go back to your doctor and discuss what changes could be made to help. This may include switching to a different medication.

Alcohol

You can drink alcohol in moderation while taking aripiprazole, but the two together could make you very sleepy.

During the first few weeks, it is recommended that you stop drinking alcohol until you see how the medicine affects you.

If you want to drink alcohol, it’s best to only drink small amounts and have a plan for getting home safely if you go out.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Antipsychotics block the effect of dopamine, so this means the ‘high’ may not be as ‘high’ as before from any drug. You may be tempted to increase your dose of the drug to make up for it, but this could be dangerous.

Cannabis can make drowsiness worse with aripiprazole.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis.

Methadone can make drowsiness worse with aripiprazole.

Aripiprazole could reduce your craving for cocaine and could reduce the level of happiness that you feel when taking cocaine.

Aripiprazole and stimulant drugs such as amfetamines can affect the heart, and this can be dangerous when taken together.

There are many other street drugs, but we don’t know what effect taking them with aripiprazole will have, so it’s best to be cautious.

There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Aripiprazole does not mix well with some other medicines, including herbal remedies.

Before you start taking aripiprazole, tell your doctor if you are taking any other medications, including things you have bought over the counter and topical applications that you put on your skin.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with aripiprazole. With some medicines your doctor may need to adjust the dose of aripiprazole if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

There are multiple companies that manufacture this medicine and the non-active ingredients may vary between products and also between the different strengths of tablets that are available.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

The tablets contain lactose so they may not be suitable for you if you have problems eating some sugars or dairy products.

The orodispersible tablets contain aspartame, which can be a problem for people with a condition called phenylketonuria.

The oral solution (liquid) contains sucralose. This should not affect your blood sugar if you’re diabetic.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking aripiprazole may make you feel very tired or dizzy and affect your eyesight when you start taking it.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days or weeks until you know how it affects you.

Most people drive as normal while taking aripiprazole. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell The DVLA (Driver and Vehicle Licensing Agency) if you have bipolar disorder, schizophrenia, schizoaffective disorder or other mental health conditions that could affect your driving. You can be fined if you do not tell DVLA about a medical condition that affects your driving and may be prosecuted if you are involved in an accident as a result.

Pregnancy

If you become pregnant while you are on aripiprazole, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing aripiprazole and help you to make a decision that is best for you and your baby. They may refer you to a specialist perinatal mental health team to support you with this decision.

If you decide to carry on taking aripiprazole during your pregnancy, make sure your midwife is aware so they can advise on extra monitoring if appropriate. During pregnancy it is standard practice for your midwife to assess your risk of blood clots. There are lots of things that can increase risk, and blood clots are also reported as a rare side effect of aripiprazole. To reduce your risk of a blood clot, your doctor or midwife may advise on the use of medicine to prevent this.

Your dose may need to increase later in your pregnancy as the body gets rid of aripiprazole more quickly. After delivery, your dose will go back to what it was before.

If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with aripiprazole.

You can find out more information about taking aripiprazole during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Remaining well is particularly important during pregnancy and while caring for a baby, so treatment with aripiprazole in pregnancy may be the best option for you.

Post-natal

There are some other symptoms that can occur in newborn babies if aripiprazole is taken in the last three months of pregnancy. Look out for these and get help if they happen:

jerking or twitching of the muscles or a tremor
being jittery, irritable or constant crying
being too hot or cold
suckling/ feeding difficulties
having stiff or floppy muscles, or overactive reflexes
being very sleepy or finding it difficult to sleep
breathing problems

These are usually mild and go away in a few days without treatment.

If your medication makes you sleepy, do not go to sleep with your baby in the same bed, and be cautious when handling your baby (especially if waking during the night for feeds). Think about support from a partner or family member to help you if needed.

Breastfeeding

Aripiprazole is passed to the baby in breast milk in small amounts.
Aripiprazole can lower the level of a hormone in the body which is needed to produce milk. In some cases, this can lead to decreased milk production.

If your baby was premature or has health problems, then you will need to be extra careful about taking medicines while breastfeeding. It may be best not to breastfeed if this is the case, but you should discuss this with your doctor or midwife.

It is important for you to remain well while you are bonding with and looking after your baby. For this reason, it may be best to take medicine for your mental health when breastfeeding.

Talk to your midwife, doctor or pharmacist if you want to breastfeed while taking aripiprazole. Make sure that your doctor, nurse, or health visitor checks your baby for any side effects.

Sex

Aripiprazole is unlikely to cause side effects that affect your sex life and is also less likely to do so than other antipsychotic medications.

In rare cases, aripiprazole can cause a long-lasting and painful erection (called priapism). This is rare, but if this happens to you, seek urgent medical help.

Raised prolactin levels are a possible side effect of aripiprazole, although this is uncommon with this medicine, and less likely compared with other antipsychotic medicines. It is more common for aripiprazole to lower prolactin levels in the body.

If you have raised prolactin levels, this could cause the following symptoms:

periods may become irregular or stop
some breast growth and milk flow, regardless of gender
decrease in libido (not feeling like you want to have sex)

It is also possible to have increased levels of prolactin and not have any symptoms.

Aripiprazole is more likely to lower prolactin levels. This is not thought to cause side effects that could affect your sex life although in rare cases it can cause erectile dysfunction (problems getting an erection or getting hard). It is unclear whether this is a side effect of aripiprazole or not.

If you do experience any side effects, they occur when you first start medication and improve over time. If they do not, and this is a problem for you, make an appointment to discuss this with your doctor.

Untreated illness can have a negative effect on your sex life, so if aripiprazole helps you to recover, positive effects can include improving your desire, experience and enjoyment of intimate relationships again.

Fertility

There is currently no evidence to show that aripiprazole directly affects fertility.

However, while uncommon with aripiprazole, a possible side effect includes increased levels of a natural hormone called prolactin in the body.

If you have raised prolactin levels (hyperprolactinaemia) this may affect your fertility, regardless of gender.

For people who menstruate, raised prolactin levels may cause problems with your menstrual cycle and you could miss periods (or they could become irregular or stop altogether). This means it may be more difficult to get pregnant.

Your doctor will monitor the levels of this hormone while you are taking aripiprazole.

Aripiprazole is less likely to cause raised prolactin compared to other antipsychotic medicines, and usually reduces levels of prolactin.

Aripiprazole is not a banned substance in sport.

Most people play sports as normal while taking aripiprazole. However, taking aripiprazole may make you feel tired and dizzy, and affect your eyesight. This could be dangerous in some sports, so it might be best not to take part in them for the first few days or weeks until you know how it affects you.

If you are worried that taking aripiprazole might make doing the sports you enjoy more difficult, discuss this with your doctor.

Ideally it is best not to take aripiprazole for the first time just before your exams.

Aripiprazole could make you feel very tired and dizzy, make you feel restless and affect your eyesight.

You should talk to your doctor about any future exams if you are starting aripiprazole. You might decide together to delay starting it until you have completed them.

If they are more than a week away, however, you might find that it is better to start aripiprazole to improve your motivation and ability to study.

Most people take exams as normal while taking aripiprazole. If you are worried that taking aripiprazole might make studying for or taking your exams harder, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking aripiprazole

Your doctor will advise you on how long it is best to keep taking your medication. This may vary depending on what you’re taking it for and how many times you’ve been unwell.

If you are prescribed aripiprazole for psychotic symptoms or schizophrenia, it is recommended that you take it for at least six months to two years after your first episode of illness. It may be appropriate to continue for longer if you had more than one episode of illness.

If you are taking aripiprazole to treat bipolar mania, then you will need to discuss long-term medicines for your bipolar disorder with your doctor. This is to help stop the illness coming back.
For bipolar disorder, it is important to remain on medicines in the long term because every time you become ill, there is more chance of you becoming ill again. Aripiprazole can be used as a long-term medicine, but there are other choices too. You should discuss your options with your doctor.

For schizoaffective disorder, it is probably best to keep taking aripiprazole for several years to reduce the chances of the illness coming back. We know less about schizoaffective disorder, but it has some similarities to bipolar disorder and some similarities to schizophrenia.

If you are taking aripiprazole to help with tics associated with Tourette Syndrome, you may continue to take this for many years if it is helping. Tics will naturally ‘wax and wane’, which means they get better and worse over time. This may make it harder to tell if your medication is still working well or not. It might be helpful to keep a diary. Your doctor will review your medication regularly with you.

If you are taking aripiprazole to help with feelings and emotions like severe agitation or irritability or aggression, your doctor will review your medication with you regularly.

You will get the best effect from aripiprazole if you take it every day at the dose prescribed by your doctor.

You will usually take your dose once a day (or once a month if you are receiving long-acting injections).

It doesn’t matter what time you take it each day but try to take it at about the same time every day. Choose a time that you can always remember. This could be a mealtime, or when you brush your teeth.
Aripiprazole can cause problems with your sleep if you take it in the evening or at bedtime so you might find it better to take it in the morning, unless it makes you feel very tired.

You can take the tablets or liquid before or after food.

For the normal coated tablets, swallow them whole with a drink of water – if you chew them, they taste bitter.

To take an orodispersible tablet, put one on your tongue and let it dissolve there. You can also dissolve it in some water if you prefer.
The oral solution should not be diluted with any drink or mixed with food before taking. If this makes taking your medicine difficult, talk to your pharmacist for advice.

If you are prescribed the long-acting injection, a nurse will administer this once a month when your dose is due. This will either be at your GP surgery or with a specialist team. When you first start receiving it, you may also need to continue taking tablets for a few weeks until the level of medicine in your body released from the injection is high enough. Your doctor will advise you about this.

If you forget to take a dose, then just take it as soon as possible.
If you forget to take it by the time your next dose is due, only take the next dose. Do not try and catch up by taking a double dose.

If you miss your appointment for your injection, contact your doctor or nurse straight away to make another appointment.

If you forget to take your medicine for a few days (or miss an injection), you may start getting your old symptoms back or get withdrawal symptoms. Talk to your doctor if this happens.

Regularly forgetting to take your medication can increase the risk of you becoming ill again and may mean that your symptoms could be worse if you become unwell again.

If you are struggling to remember to take your medication regularly as prescribed by your doctor, speak to your pharmacist and doctor for advice to help you.

Stopping the medication causes the balance of chemicals in the brain to change, so it is recommended that you stop gradually over a month or more. Don’t suddenly stop aripiprazole as soon as you start to feel better, as this could increase the risk of you becoming unwell again.

Discuss stopping your medication with your doctor. If you have important events coming up or are going through a period of life which is very demanding, it might not be the best time to stop your medication. Planning and support are important to stopping your medication successfully.

Aripiprazole is not addictive, but if stopped suddenly you may get discontinuation or withdrawal symptoms and increase the risk of becoming unwell again.

Once you start taking an antipsychotic medicine, the brain adjusts to having a new level of dopamine around. If you stop taking it suddenly, the balance starts to change. It takes time for your body to readjust, and you may be more sensitive to the levels of dopamine that are in your body.

Some of the withdrawal symptoms may be like symptoms you had when you were unwell, so understandably, you might feel anxious or upset that your illness could be returning.

Withdrawal symptoms usually start within a few days of stopping (or sometimes reducing) your medication. A wide range of symptoms have been reported and are listed below. You may experience a few or a range of these:

difficulty getting to sleep or disturbed sleep
low mood, feeling anxious or agitated or restless
dizziness or light-headedness
headaches
reduced concentration or feeling confused
feeling sick or being sick, diarrhoea
flu-like symptoms
tense or jerky muscles and slow movements
uncontrollable movement of face or body
hallucinations, intrusive thoughts

It is not possible to predict if you will experience withdrawal symptoms or how bad they will be if you do experience them. If you do experience symptoms, they are usually mild and don’t last long, but for some these could be severe enough to make you feel very unwell and last longer (two to three months or more). Arrange an appointment with your doctor to discuss your symptoms and seek advice if you are concerned or unable to tolerate them.

You can stop taking aripiprazole safely with your doctor’s help. Planning a gradual withdrawal together can help to minimise or prevent the withdrawal symptoms you experience.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

feeling sleepy or tired
feeling or being sick
unusual body movements you can’t control
problems standing and walking
feeling dizzy (due to low blood pressure) or fainting
fast or uneven heartbeat
seizure or fits

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

While taking aripiprazole you may have thoughts about hurting yourself or taking your own life. These thoughts could be caused by mental illness or may be a side effect of your medicine.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Aripiprazole can cause serious side effects, including allergic reactions.

Stop taking aripiprazole and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing, swallowing, swelling in the mouth, tongue, face and throat, itching or a rash (these could indicate an allergic reaction to the medication)
muscles going stiff or rigid with high fever, sweating, looking pale, feeling strange and fainting or losing consciousness, or very rapid or irregular heartbeat (these may indicate a rare but life-threatening side effect called neuroleptic malignant syndrome)
a painful erection (priapism) that lasts more than two hours

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking aripiprazole, if you get any of the following symptoms:

movements of the tongue, mouth and face that you cannot control (this could be a condition called tardive dyskinesia)
tensing or contraction of muscles that you are not able to control (this could affect any muscle, including your eyes, mouth, tongue or jaw)
uncomfortable feeling or restlessness and needing to move constantly
you develop new symptoms which include needing to drink a lot, needing to pee a lot, feeling weak, or increased appetite and feeling hungry (these might indicate your body is not processing sugar very well)
trouble controlling urges, impulses or temptations to do things that could be harmful to you or others (like gambling, uncontrollable excessive shopping, binge or compulsive eating, increased sex drive)
any unusual bleeding or bruising
sudden fever, sore throat or mouth ulcers
swelling, pain, and redness in the leg, which may lead to chest pain and difficulty breathing (this might be a blood clot)
yellowing of the skin or whites of the eyes (these may be signs of hepatitis)
a sudden change in your mental state, or difficulty with your memory

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking a new medicine. Many go away as you continue your medicine. In the first two or three weeks of taking aripiprazole, side effects like feeling agitated and restless or feeling sick may make you feel generally worse. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor, specialist team or pharmacist about them.

Young people are more likely than adults to get the following side effects:

extreme tiredness and sleepiness
dry mouth
strange movements and twitches of muscles
dizziness
increased appetite and weight gain
restlessness
pain in the abdomen (belly)
fast heartbeat

Common side effects for both children and adults taking aripiprazole include:

uncontrollable twitching or jerking movements
feeling anxious or restless
feeling or being sick
discomfort or pain in the stomach
constipation (difficulty pooing)
lightheadedness
trouble sleeping
blurred eyesight

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Aripiprazole has also been known to make it hard for people to resist impulses and urges, like gambling to extremes, excessive and uncontrollable shopping or binge-eating. If you have ever had problems with gambling in the past, you should talk to your doctor about this before you take it. If you experience a change in behaviour after you start taking aripiprazole, discuss this with your doctor.

You should have your weight, blood sugar, blood fats, prolactin level and blood pressure and pulse measured before you start aripiprazole and regularly during early treatment, then at least every six months (if you are 17 years old or younger) or once a year (if 18 years or older) after that.

A blood test will be required to check your blood sugar, blood fats and prolactin level.

Your doctor might also recommend additional monitoring. This might include checking your heart with an electrocardiogram (ECG) or checking your liver function. This is done by taking a blood test.
They might also check your height and development. If you have periods, they may ask if there have been any changes to the pattern or frequency of these.

It is very important to go for these checks when you are asked to do so. If you are worried or anxious about the monitoring, talk to your doctor, care team or practice nurse about this for advice and support.

You could take some of these measurements at home (e.g. weight) and keep a record of the results to share with your doctor when they review your treatment.