Aripiprazole

How it works

What does aripiprazole do?

Aripiprazole is a ‘second-generation antipsychotic’ (sometimes described as an ‘atypical antipsychotic’).

Research suggests that mania and psychosis are more likely to occur when parts of the brain have too much of a chemical called dopamine. This theory is based on the fact that amphetamines, which are stimulants that release dopamine, can bring on psychosis in people who do not have the condition.

An antipsychotic medicine helps to adjust the levels of dopamine and other chemicals available in your brain. 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.

How long does aripiprazole take to start working?

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

If you have seen no change in symptoms after two or three weeks, you should talk to your doctor about your progress.

Your doctor needs to know if...

You need to talk to your doctor or pharmacist before starting treatment with aripiprazole if any of the following apply to you:

• you have high blood sugar (symptoms include being thirsty all the time, weeing a lot, increased appetite and/or feeling weak) or if you have a family history of diabetes
• you have ever had seizures (fits)
• you have had strange muscle movements that you could not control, especially in the face
• you have heart problems, or you have a family history of heart problems
• you have had a stroke or "mini" stroke
• you have high or low blood pressure
• you have had blood clots, or you have a family history of blood clots
• you have ever been addicted to gambling

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

The orodispersible tablets (melts) 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.

Check with your doctor if you’re concerned about any of aripiprazole’s ingredients.

Taking aripiprazole

You should only take aripiprazole as agreed with your doctor.

You can take aripiprazole as tablets, orodispersible tablets (melts), liquid, a short-acting injection or a long-acting monthly injection.

You may start taking the liquid on a low dose before moving on to tablets when your dose increases.

You will get the best effect from aripiprazole if you take it regularly.

Make sure that you know your dose. If it's not written on the label, check with your pharmacist or doctor.

You will usually take your dose once a day.

It doesn’t matter what time you take it each day – choose a time that you can always remember. This could be a mealtime, or when you brush your teeth.

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 (melt), put one on your tongue and let it dissolve there. You can also dissolve it in some water if you prefer.

You cannot mix the oral solution with any drink or food. It must be taken on its own.

A doctor or nurse can give you a fast-acting dose of aripiprazole by injection if you are very agitated. You can have a tablet at the same time – under the supervision of a doctor – which will make the effect last longer.

If you start receiving the long-acting injection, you may also have be given some tablets to take until the medicine level is high enough in your body.

What if I miss a dose?

If you forget to take a dose, then just take it as soon as possible.

If you forget to take it by your next dose, only take the next dose.

Do not take a double dose.

What will happen if I forget to take my aripiprazole?

If you forget to take your medicine for a few days, you may start getting your old symptoms back. Talk to your doctor if this happens.

Stopping the use of aripiprazole

Stopping the medication causes the balance of chemicals in the brain to change.

Once you start taking an antipsychotic, the brain adjusts to having a new level of dopamine around. If you stop taking it suddenly, the balance starts to change, and your old symptoms could return.

You could also experience some unpleasant withdrawal symptoms like headache, feeling sick and sleep problems.

You can stop taking aripiprazole safely with your doctor’s help. They will work with you to reduce your dose gradually rather than stopping suddenly. The speed at which you reduce depends on how unwell you were and how long you have been on aripiprazole.

The information on this page was reviewed by the College of Mental Health Pharmacy in October 2019.

Safety headlines

If you have taken more aripiprazole than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Take a friend with you if possible, in case you start to feel ill on the way.

While taking aripiprazole, some people may think about hurting themselves or taking their own lives. You must go straight to hospital with your tablets if you have any of these thoughts.

Aripiprazole can cause serious side effects like allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps) and other serious symptoms, which are listed under the 'Side effects' tab. Go to a hospital if you experience any of these effects, taking your medicine with you.

Stopping aripiprazole suddenly might cause unpleasant withdrawal effects – go to your doctor if you want to stop, or if you are having these effects.

You might feel sleepy or dizzy in the first few days after taking aripiprazole – do not drive a car, ride a bike or operate machines until you see how this affects you.

If you take aripiprazole while you are pregnant, there is nothing to suggest it will harm the developing baby, though the medication can cause symptoms in newborn babies. Use good contraception while you are taking aripiprazole and tell your doctor if you want to start trying for a baby.  

When to go to hospital

If you have taken more aripiprazole than the dosage recommended by the doctor who prescribed it to you, go to A&E and take your medication with you - even if you don’t feel different. Take a friend with you if possible, in case you start to feel ill on the way.

You might get any of the following signs:

• tiredness and sleepiness
• fast heartbeat
• diarrhoea
• feeling or being sick
• fainting or losing consciousness
• strange movements of your muscles that you cannot control

While taking aripiprazole, some people think about hurting themselves or taking their own lives. This can happen to anyone, including people who are under 18. You must go straight to hospital with your tablets if you have any of these thoughts. Take a friend or family member with you to keep you safe on the way.

Stop taking your medicine and seek medical help straight away if you get any of the following symptoms:

• difficulty 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 tachycardia (very rapid or irregular heartbeat). These may indicate a life-threatening side effect called neuroleptic malignant syndrome.

When to see your doctor

If you start to experience muscle spasms or abnormal bodily movements that you cannot control, you should go and see your doctor as soon as possible.

Antipsychotic medications can cause a wide variety of problems with movement such as tremors, restlessness, agitation and unusual movement of the lips, tongue, hands or pelvis. If the movements are severe then you might find it difficult to speak, eat or breathe. These are called extrapyramidal side effects (EPS). Aripiprazole is less likely to cause these movements than some of the other antipsychotics.

A subgroup of the movement side effects is called tardive dyskinesia. This is an uncommon side effect of aripiprazole. It occurs in less than one in 100 people and can be a legacy of taking earlier antipsychotics.

The first sign might be some movements of your tongue that you cannot control, and they may be quite regular and rhythmic. The problem with tardive dyskinesia is that it might not stop, even if you stop taking your medicine.

If you notice it early and act with your doctor, the problem should not get worse.

Side effects

In the first two or three weeks of taking aripiprazole, side effects (such as feeling agitated and restless, or feeling sick) may make you feel generally worse. They should wear off quite quickly but if they are a problem, speak to your doctor or care team.

The side effects that come with aripiprazole are different to those of many other antipsychotics, but they can be serious.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

Young people aged 13 and over 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. Please look at the paper leaflet inside your medicine box, or ask a doctor or pharmacist, if you want to know if you are getting a side effect from your medicine.

If you do get a side effect, please think about reporting it to the Yellow Card scheme.

Aripiprazole has also been known to make people feel like gambling to extremes. If you have ever had problems with gambling in the past, you should talk to your doctor about this before you take it.

Body

A side effect of aripiprazole can be both weight loss and weight gain, although it is less likely to cause weight gain than other antipsychotic medicines.

It is very difficult to know how it will affect each person who takes it.

Sometimes aripiprazole is given to people taking other antipsychotics to not only help their symptoms but also to reverse some of the weight gained.

Your doctor should measure your weight regularly when you are taking aripiprazole.

Young people will gain some weight each year as they grow, but anything more than that should be watched.

If you put on weight, there are other antipsychotic medicines you can try, or ways to try and lose it again. Talk to your doctor about this if it worries you.

Sleep

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.

Go back to your doctor if this causes a big problem for you.

Sex and fertility

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). 

If it works for you, aripiprazole may have a positive effect on your sex life as your symptoms settle, and you can concentrate on your relationships.

If you have a penis, you can get an erection that is painful and lasts for a long time (priapism) when taking aripiprazole. If this happens, you must go to a doctor straight away.

Fertility

There is no information to suggest aripiprazole has any effects on fertility.

You should use a good contraceptive while taking aripiprazole and talk to your doctor about options if you are trying to get pregnant.

Pregnancy, post-natal and breastfeeding

Pregnancy

There is nothing to suggest aripiprazole will harm the developing baby during pregnancy.

If you decide to carry on taking aripiprazole through your pregnancy, you should talk to your doctor and midwife about it before the birth.

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.

Post-natal

Aripiprazole can cause some symptoms in newborn babies – for instance, your baby might be born a little earlier than expected and may suffer from agitation, muscle spasm or weakness, shaking, drowsiness, feeding problems or breathing problems.

You will need help from the midwife and doctors, so it is better if they are looking out for these side effects. These usually are mild and go away in a few days without treatment.

Breastfeeding

Aripiprazole is passed to the baby in breast milk in small amounts. Breastfeeding may offset some of the symptoms. Talk to your doctor or midwife about your feeding options or ask to be referred to a lactation consultant.

Driving and transport

Do not drive a car or ride a bike just after you start taking aripiprazole.

Taking aripiprazole may make you feel very tired or dizzy and/or 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, until you know how it affects you.

Do not worry - most people drive as normal while taking aripiprazole.

School and exams

Try 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 to study.

Do not worry - most people take exams as normal while taking aripiprazole.

Friends and family

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.

Sport

Aripiprazole is not a banned substance in sport.

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.

Do not worry - most people do sports as normal while taking aripiprazole.

Alcohol and street drugs

Alcohol

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

During the first few days, it might be best to stop drinking alcohol until you see how the medicine affects you.

If you want to drink alcohol, plan how you will get home safely if you feel sleepy.  

Street drugs

Be careful if you are also using 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. For more information, have a look at our drugs and alcohol page.

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 amphetamines can affect the heart, and this can be dangerous when taken together.

Prescription medicines

Tell your doctor or pharmacist before you take aripiprazole if you are prescribed any other medication, to check that the combination is safe.  

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

Monitoring

You should have your weight, height, waist circumference and blood pressure checked regularly while you are taking aripiprazole.

Your doctor should also do blood tests to check your liver, blood sugar, and some hormones before and regularly during your treatment.

You may also have a heart test called an electrocardiogram (ECG) before you start treatment - and periodically while taking aripiprazole - if you are at risk of heart disease.

References and further reading

For more helpful links and information, have a look at our references and further reading page.