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Comprehensive categorization: +Third-Generation Antipsychotics
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{{MedTemplate
{{MedTemplate
| generic           = Aripiprazole
| generic           = Aripiprazole
| brand             = Abilify
| brand             = Abilify (oral), Abilify Maintena (monthly IM LAI), Aristada (aripiprazole lauroxil IM LAI), Abilify Asimtufii (bi-monthly IM LAI), Abilify MyCite (digital ingestion sensor)
| structure         =  
| structure         =
| classes           = Antipsychotic, Neuroleptic
| classes           = [[:Category:Neuroleptics|Neuroleptic]], [[:Category:Atypical neuroleptics|Atypical neuroleptic]], [[:Category:Third-generation neuroleptics|Third-generation neuroleptic]], [[:Category:Mood stabilizers|Mood stabilizer]]
| mechanism          = D2/D3 partial agonist; 5-HT1A partial agonist; 5-HT2A antagonist
| uses              = <vote slug="schizophrenia-use">Schizophrenia (FDA, ages 13+)</vote>, <vote slug="bipolar-mania-mixed-use">Bipolar mania and mixed episodes (FDA)</vote>, <vote slug="bipolar-maintenance-use">Bipolar maintenance (FDA)</vote>, <vote slug="mdd-adjunct-use">Major depressive disorder adjunct (FDA)</vote>, <vote slug="autism-irritability-use">Autism spectrum disorder-associated irritability (FDA, pediatric ages 6-17)</vote>, <vote slug="tourette-syndrome-pediatric-use">Tourette syndrome (FDA, pediatric)</vote>
| uses              =  
| starting_dose    = Schizophrenia/bipolar mania: 10-15 mg PO once daily, target 15-30 mg. MDD adjunct: 2-5 mg/day, target 5-15 mg. Pediatric autism irritability: 2 mg, titrate to 5-15 mg. Maintena LAI: 400 mg IM every 4 weeks after oral overlap
| starting_dose     =  
| preparations     = Tablets 2, 5, 10, 15, 20, 30 mg; ODT 10, 15 mg; oral solution 1 mg/mL; acute IM injection 9.75 mg/1.3 mL; Maintena LAI 300, 400 mg monthly; Aristada LAI 441, 662, 882, 1064 mg (4-8 week dosing); Asimtufii bi-monthly
| preparations      =  
| fda_max          = 30 mg/day (adult schizophrenia); 15 mg/day (MDD adjunct)
| fda_max           =  
| pill_id           =
| routes             =  
| routes           = Oral, intramuscular (acute and long-acting)
| onset             =  
| onset             = Neuroleptic effect emerges over days to weeks; activation symptoms (akathisia, insomnia) often within days
| duration           =  
| duration         = 24 hours (oral); 4-8 weeks (LAI)
| halflife           =
| halflife          = ~75 hours (long, accumulates over weeks)<ref name="abilify-label">FDA Prescribing Information, Abilify (aripiprazole), Otsuka/Bristol-Myers Squibb, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021436s038,021713s030,021729s022,021866s023lbl.pdf</ref>
| bioavailability    =
| bioavailability   = ~87% (oral)<ref name="abilify-label" />
| pregnancy         =  
| pregnancy        = Limited human data; signal for neonatal extrapyramidal symptoms and withdrawal with third-trimester exposure.{{citation needed}}
| legal              =  
| legal             = [[USLegal:Prescription only|Rx-only]] in US. Carries the atypical-neuroleptic '''Boxed Warning''' for increased mortality in elderly patients with dementia-related psychosis, and the antidepressant suicidality '''Boxed Warning''' when used for MDD adjunct in patients under 24<ref name="abilify-label" />
| intro              =
| mechanism         = <vote slug="aripiprazole-mech-claim">'''D2 and D3 dopamine receptor partial agonist''' (the third-generation neuroleptic signature, distinct from olanzapine/risperidone full D2 antagonism), with additional 5-HT1A partial agonism and 5-HT2A receptor antagonism. The D2 partial agonism is the "dopamine system stabilizer" rationale: in hyperdopaminergic states (psychosis, mania) aripiprazole functions as a partial antagonist; in hypodopaminergic states (prefrontal cortex, MDD adjunct) it functions as a partial agonist.</vote> '''Akathisia''' is the most common dose-limiting adverse effect, particularly with the MDD-adjunct dose range. Lower weight gain, lower metabolic burden, and lower prolactin elevation than most second-generation neuroleptics, the principal pharmacological selling points. CYP2D6 and CYP3A4 metabolism; CPIC PGx guidance applies for CYP2D6 dose individualization<ref name="abilify-label" />.
| pharmacokinetics   =  
| pharmacodynamics  =  
| indications        =  
| dosing             =  
| effects            =  
| interactions      = <pharmaInteractions/>
| pregnancy_details  =
| monitoring         =  
| counseling        =  
| anecdotes          =
| seealso            =
| references        =  
}}
}}


== References ==
<references />


[[Category:Antipsychotics / Neuroleptics]]
[[Category:Second-Generation Antipsychotics (SGAs / Atypicals)]]
[[Category:Neuroleptics]]
[[Category:Neuroleptics]]
[[Category:Third-Generation Antipsychotics]]
[[Category:Atypical neuroleptics]]
[[Category:Third-generation neuroleptics]]
[[Category:Mood stabilizers]]

Latest revision as of 10:40, 23 May 2026

Neuroleptic, Atypical neuroleptic, Third-generation neuroleptic, Mood stabilizer
Aripiprazole
Abilify (oral), Abilify Maintena (monthly IM LAI), Aristada (aripiprazole lauroxil IM LAI), Abilify Asimtufii (bi-monthly IM LAI), Abilify MyCite (digital ingestion sensor)

Experience

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Problems

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Titration strategies

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Effects

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Summary
Classes
Neuroleptic, Atypical neuroleptic, Third-generation neuroleptic, Mood stabilizer
Common uses
Schizophrenia (FDA, ages 13+)0, Bipolar mania and mixed episodes (FDA)0, Bipolar maintenance (FDA)0, Major depressive disorder adjunct (FDA)0, Autism spectrum disorder-associated irritability (FDA, pediatric ages 6-17)0, Tourette syndrome (FDA, pediatric)0
Pharmacy
Starting dose
Schizophrenia/bipolar mania: 10-15 mg PO once daily, target 15-30 mg. MDD adjunct: 2-5 mg/day, target 5-15 mg. Pediatric autism irritability: 2 mg, titrate to 5-15 mg. Maintena LAI: 400 mg IM every 4 weeks after oral overlap
Preparations
Tablets 2, 5, 10, 15, 20, 30 mg; ODT 10, 15 mg; oral solution 1 mg/mL; acute IM injection 9.75 mg/1.3 mL; Maintena LAI 300, 400 mg monthly; Aristada LAI 441, 662, 882, 1064 mg (4-8 week dosing); Asimtufii bi-monthly
US FDA Max
30 mg/day (adult schizophrenia); 15 mg/day (MDD adjunct)
Pharmacology
Routes
Oral, intramuscular (acute and long-acting)
Onset
Neuroleptic effect emerges over days to weeks; activation symptoms (akathisia, insomnia) often within days
Duration
24 hours (oral); 4-8 weeks (LAI)
Half-life
~75 hours (long, accumulates over weeks)[1]
Bioavailability
~87% (oral)[1]
Pregnancy
Limited human data; signal for neonatal extrapyramidal symptoms and withdrawal with third-trimester exposure.[citation needed]
Legal status
Rx-only in US. Carries the atypical-neuroleptic Boxed Warning for increased mortality in elderly patients with dementia-related psychosis, and the antidepressant suicidality Boxed Warning when used for MDD adjunct in patients under 24[1]
Purported mechanism
D2 and D3 dopamine receptor partial agonist (the third-generation neuroleptic signature, distinct from olanzapine/risperidone full D2 antagonism), with additional 5-HT1A partial agonism and 5-HT2A receptor antagonism. The D2 partial agonism is the "dopamine system stabilizer" rationale: in hyperdopaminergic states (psychosis, mania) aripiprazole functions as a partial antagonist; in hypodopaminergic states (prefrontal cortex, MDD adjunct) it functions as a partial agonist.0 Akathisia is the most common dose-limiting adverse effect, particularly with the MDD-adjunct dose range. Lower weight gain, lower metabolic burden, and lower prolactin elevation than most second-generation neuroleptics, the principal pharmacological selling points. CYP2D6 and CYP3A4 metabolism; CPIC PGx guidance applies for CYP2D6 dose individualization[1].

References

  1. ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Abilify (aripiprazole), Otsuka/Bristol-Myers Squibb, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021436s038,021713s030,021729s022,021866s023lbl.pdf
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