An atypical antipsychotic (dopamine "partial agonist")
Aripiprazole
An atypical antipsychotic for schizophrenia and bipolar disorder that tends to be more weight-neutral, but can cause restlessness and, rarely, impulse-control problems.
What is Aripiprazole?
Aripiprazole is an atypical, or second-generation, antipsychotic used for schizophrenia and for bipolar disorder, including the manic phase and longer-term stabilisation. It works differently from some other antipsychotics and tends to be less sedating.
Education and reference only. This is a plain-language guide to Aripiprazole — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Aripiprazole is an atypical (second-generation) antipsychotic used for schizophrenia and for bipolar disorder, including the manic phase and longer-term stability. It works in a slightly different way from most antipsychotics, acting as a dopamine "partial agonist" — steadying rather than simply blocking dopamine. In practice it tends to be more weight-neutral and less sedating than olanzapine, which is often why it is chosen, though it has its own distinctive effects, chiefly restlessness.
How it works
Most antipsychotics fully block dopamine receptors. Aripiprazole instead partly activates them: where dopamine is overactive (driving psychosis or mania) it turns the signal down, and where dopamine is low it provides a little activity — acting like a "dimmer switch" that aims for balance. It also adjusts serotonin signalling. This balancing action is thought to explain why it is generally less sedating and less likely to cause weight gain than some other antipsychotics, while still controlling symptoms.
Company & origin
Originated / developed by: Otsuka Pharmaceutical.
Aripiprazole, a dopamine D2 partial-agonist antipsychotic, was discovered by Japan's Otsuka Pharmaceutical and co-developed with Bristol-Myers Squibb. It was first approved by the US FDA in November 2002, marketed as Abilify.
What it treats
Conditions Aripiprazole is used for
Practical use
How to take Aripiprazole
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually taken once a day, with or without food, at a regular time.
- Keep taking it even when you feel better, as stopping can lead to relapse.
- Do not stop suddenly without medical advice.
- Tell your doctor if you feel restless or unable to sit still, which can occur early on.
- Mention any unusual urges, such as gambling, as these have rarely been linked to this medicine.
- Attend appointments for the checks your doctor arranges.
Weighing it up
Advantages & disadvantages of Aripiprazole
Advantages
- Effective for schizophrenia and bipolar disorder.
- Tends to cause less weight gain and sedation than some other antipsychotics.
- Taken once daily.
Disadvantages
- Can cause restlessness, sleep disturbance or nausea, especially early in treatment.
- Has rarely been associated with impulse-control problems such as gambling.
- Still needs monitoring, as metabolic effects can occur.
- Should not be stopped abruptly because of the risk of relapse.
Practical use
Good to know
It is taken regularly, usually once a day, and is often less sedating than other antipsychotics — so it can be taken in the morning, and some people actually find it slightly activating. It should not be stopped abruptly; changes are made gradually with support. A common early effect is akathisia, an inner restlessness or inability to keep still, which is worth reporting as it can often be eased. Rarely, it has been linked to impulse-control problems such as compulsive gambling, shopping, eating or sexual urges — these can come on without warning and should be reported, as they usually settle when the medicine is reviewed.
Who should not take it / use with caution
- Older people with dementia should generally not take it for behavioural symptoms, as antipsychotics raise the risk of stroke and death in this group.
- Used with caution in people with significant heart disease or a history of heart-rhythm problems, in those prone to seizures, and in Parkinson's disease.
- Caution in people with a history of impulse-control problems or compulsive behaviours, in significant liver or kidney disease, and in pregnancy or breastfeeding, where the decision is individualised.
Monitoring
- Mental state and any restlessness or new compulsive behaviours
- Weight, blood sugar and blood fats (still checked, though changes tend to be smaller)
- Blood pressure and pulse
Side effects
- Restlessness or an inability to sit still (akathisia), anxiety, trouble sleeping, and sometimes feeling activated rather than calmed.
- Headache, nausea, light-headedness on standing, and tremor or other movement effects.
- Less commonly, weight gain (usually less than with olanzapine), and rarely impulse-control problems (such as gambling) or a serious reaction with fever and rigidity (neuroleptic malignant syndrome) — report new compulsive urges, high fever or severe stiffness.
Key interactions
- Some medicines (certain antifungals and some antibiotics and antidepressants) raise its levels, while others (such as carbamazepine and some epilepsy medicines) lower them, so combinations may need adjustment.
- Other sedating medicines, opioids and alcohol can add to drowsiness in those who do find it sedating.
- Care alongside Parkinson's medicines (it can oppose them) and other medicines affecting the heart's rhythm.
Available as: Tablets, orodispersible tablets that melt on the tongue, an oral liquid, and long-acting injections given in a clinical setting.
Answers
Aripiprazole: frequently asked questions
Is aripiprazole better than olanzapine for weight?
It tends to be more weight-neutral and less sedating than olanzapine, which is often why it is chosen — though weight, blood sugar and blood fats are still checked. The trade-off is that aripiprazole is more likely to cause restlessness (akathisia). The "best" antipsychotic depends on the individual and is matched to your symptoms and what you can tolerate.
I feel restless and can't sit still — is that the medicine?
Possibly. An inner restlessness or inability to keep still, called akathisia, is one of aripiprazole's more characteristic effects. It can be distressing but is usually treatable — tell your prescriber rather than stopping on your own, as adjusting the medicine or adding support often helps.
I've heard it can cause gambling — is that true?
Rarely, aripiprazole has been linked to impulse-control problems such as compulsive gambling, shopping, binge eating or heightened sexual urges. These can appear without obvious warning. If you or those around you notice new compulsive behaviour, report it — it usually settles once the medicine is reviewed or changed.
Should I take it in the morning or at night?
Because aripiprazole is usually less sedating than other antipsychotics — and can even feel slightly activating — many people take it in the morning. Follow your prescriber's advice, and if it disturbs your sleep or makes you drowsy, mention it so the timing can be adjusted.
What is the difference between aripiprazole and Abilify?
They are the same medicine — aripiprazole is the generic (active-ingredient) name and Abilify is the brand. Generic aripiprazole contains the identical active ingredient and works the same way; it is usually cheaper.
The wider class
About Antipsychotics
Aripiprazole belongs to the antipsychotics class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Aripiprazole.
- electronic Medicines Compendium (SmPC): Aripiprazole (Abilify).
- NICE: Bipolar disorder — assessment and management.
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