SIDE EFFECTS
Overall Adverse Reactions Profile
The following are discussed in more detail in other sections of the labeling:
- Use in Elderly Patients with Dementia-Related Psychosis [see BOXED WARNING and WARNINGS AND PRECAUTIONS]
- Clinical Worsening of Depression and Suicide Risk [see BOXED WARNING and WARNINGS AND PRECAUTIONS]
- Neuroleptic Malignant Syndrome (NMS) [see WARNINGS AND PRECAUTIONS]
- Tardive Dyskinesia [see WARNINGS AND PRECAUTIONS]
- Hyperglycemia and Diabetes Mellitus [see WARNINGS AND PRECAUTIONS]
- Orthostatic Hypotension [see WARNINGS AND PRECAUTIONS]
- Leukopenia, Neutropenia, and Agranulocytosis [see WARNINGS AND PRECAUTIONS]
- Seizures/Convulsions [see WARNINGS AND PRECAUTIONS]
- Potential for Cognitive and Motor Impairment [see WARNINGS AND PRECAUTIONS]
- Body Temperature Regulation [see WARNINGS AND PRECAUTIONS]
- Suicide [see WARNINGS AND PRECAUTIONS]
- Dysphagia [see WARNINGS AND PRECAUTIONS]
- Use in Patients with Concomitant Illness [see WARNINGS AND PRECAUTIONS]
The most common adverse reactions in adult patients in clinical trials ( ≥ 10%) were nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, insomnia, and restlessness.
The most common adverse reactions in the pediatric clinical trials ( ≥ 10%) were somnolence, extrapyramidal disorder, headache, and nausea.
Aripiprazole has been evaluated for safety in 13,543 adult patients who participated in multiple-dose, clinical trials in Schizophrenia, Bipolar Disorder, Major Depressive Disorder, Dementia of the Alzheimer's type, Parkinson's disease, and alcoholism, and who had approximately 7619 patient-years of exposure to oral aripiprazole and 749 patients with exposure to aripiprazole injection. A total of 3390 patients were treated with oral aripiprazole for at least 180 days and 1933 patients treated with oral aripiprazole had at least 1 year of exposure.
Aripiprazole has been evaluated for safety in 514 patients (10 to 17 years) who participated in multiple-dose, clinical trials in Schizophrenia or Bipolar Mania and who had approximately 205 patient-years of exposure to oral aripiprazole. A total of 278 pediatric patients were treated with oral aripiprazole for at least 180 days.
The conditions and duration of treatment with aripiprazole (monotherapy and adjunctive therapy with antidepressants or mood stabilizers) included (in overlapping categories) double-blind, comparative and noncomparative open-labe studies, inpatient and outpatient studies, fixed- and flexible-dose studies, and short- and longer-term exposure.
Adverse events during exposure were obtained by collecting volunteered adverse events, as well as results of physical examinations, vital signs, weights, laboratory analyses, and ECG. Adverse experiences were recorded by clinical investigators using terminology of their own choosing. In the tables and tabulations that follow, MedDRA dictionary terminology has been used to classify reported adverse events into a smaller number of standardized event categories, in order to provide a meaningful estimate of the proportion of individuals experiencing adverse events.
The stated frequencies of adverse reactions represent the proportion of individuals who experienced at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. There was no attempt to use investigator causality assessments; ie, all events meeting the defined criteria, regardless of investigator causality are included.
Throughout this section, adverse reactions are reported. These are adverse events that were considered to be reasonably associated with the use of ABILIFY (adverse drug reactions) based on the comprehensive assessment of the available adverse event information. A causal association for ABILIFY often cannot be reliably established in individual cases.
The figures in the tables and tabulations cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatment, uses, and investigators. The cited figures, however, do provide the prescriber with some basis for estimating the relative contribution of drug and nondrug factors to the adverse reaction incidence in the population studied.
Clinical Studies Experience
Adult Patients with Schizophrenia
The following findings are based on a pool of five placebo-controlled trials (four 4-week and one 6-week) in which oral aripiprazole was administered in doses ranging from 2 mg/day to 30 mg/day.
Adverse Reactions Associated with Discontinuation of Treatment
Overall, there was little difference in the incidence of discontinuation due to adverse reactions between aripiprazole-treated (7%) and placebo-treated (9%) patients. The types of adverse reactions that led to discontinuation were similar for the aripiprazole-treated and placebo-treated patients.
Commonly Observed Adverse Reactions
The only commonly observed adverse reaction associated with the use of aripiprazole in patients with Schizophrenia (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) was akathisia (aripiprazole 8%; placebo 4%).
Adult Patients with Bipolar Mania
Monotherapy
The following findings are based on a pool of 3-week, placebo-controlled, Bipolar Mania trials in which oral aripiprazole was administered at doses of 15 mg/day or 30 mg/day.
Adverse Reactions Associated with Discontinuation of Treatment
Overall, in patients with Bipolar Mania, there was little difference in the incidence of discontinuation due to adverse reactions between aripiprazole-treated (11%) and placebo-treated (10%) patients. The types of adverse reactions that led to discontinuation were similar between the aripiprazole-treated and placebo-treated patients.
Commonly Observed Adverse Reactions
Commonly observed adverse reactions associated with the use of aripiprazole in patients with Bipolar Mania (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) are shown in Table 5.
Table 5: Commonly Observed Adverse Reactions in Short-Term, Placebo-Controlled Trials of Adult Patients with Bipolar Mania Treated with Oral ABILIFY Monotherapy
| Preferred Term | Percentage of Patients Reporting Reaction | |
| Aripiprazole (n=917) | Placebo (n=753) | |
| Akathisia | 13 | 4 |
| Sedation | 8 | 3 |
| Restlessness | 6 | 3 |
| Tremor | 6 | 3 |
| Extrapyramidal Disorder | 5 | 2 |
Less Common Adverse Reactions in Adults
Table 6 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks in Schizophrenia and up to 3 weeks in Bipolar Mania), including only those reactions that occurred in 2% or more of patients treated with aripiprazole (doses ≥ 2 mg/day) and for which the incidence in patients treated with aripiprazole was greater than the incidence in patients treated with placebo in the combined dataset.
Table 6: Adverse Reactions in Short-Term, Placebo-Controlled Trials in Adult Patients Treated with Oral ABILIFY
| System Organ Class Preferred Term | Percentage of Patients Reporting Reactiona | |
| Aripiprazole (n=1843) | Placebo (n=1166) | |
| Eye Disorders | ||
| Blurred Vision | 3 | 1 |
| Gastrointestinal Disorders | ||
| Nausea | 15 | 11 |
| Constipation | 11 | 7 |
| Vomiting | 11 | 6 |
| Dyspepsia | 9 | 7 |
| Dry Mouth | 5 | 4 |
| Toothache | 4 | 3 |
| Abdominal Discomfort | 3 | 2 |
| Stomach Discomfort | 3 | 2 |
| General Disorders and Administration Site Conditions | ||
| Fatigue | 6 | 4 |
| Pain | 3 | 2 |
| Musculoskeletal and Connective Tissue Disorders | ||
| Musculoskeletal Stiffness | 4 | 3 |
| Pain in Extremity | 4 | 2 |
| Myalgia | 2 | 1 |
| Muscle Spasms | 2 | 1 |
| Nervous System Disorders | ||
| Headache | 27 | 23 |
| Dizziness | 10 | 7 |
| Akathisia | 10 | 4 |
| Sedation | 7 | 4 |
| Extrapyramidal Disorder | 5 | 3 |
| Tremor | 5 | 3 |
| Somnolence | 5 | 3 |
| Psychiatric Disorders | ||
| Agitation | 19 | 17 |
| Insomnia | 18 | 13 |
| Anxiety | 17 | 13 |
| Restlessness | 5 | 3 |
| Respiratory, Thoracic, and Mediastinal Disorders | ||
| Pharyngolaryngeal Pain | 3 | 2 |
| Cough | 3 | 2 |
| a Adverse reactions reported by at least 2% of patients treated with oral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. | ||
An examination of population subgroups did not reveal any clear evidence of differential adverse reaction incidence on the basis of age, gender, or race.
Adult Patients with Adjunctive Therapy with Bipolar Mania
The following findings are based on a placebo-controlled trial of adult patients with Bipolar Disorder in which aripiprazole was administered at doses of 15 mg/day or 30 mg/day as adjunctive therapy with lithium or valproate.
Adverse Reactions Associated with Discontinuation of Treatment
In a study of patients who were already tolerating either lithium or valproate as monotherapy, discontinuation rates due to adverse reactions were 12% for patients treated with adjunctive aripiprazole compared to 6% for patients treated with adjunctive placebo. The most common adverse drug reactions associated with discontinuation in the adjunctive aripiprazole-treated compared to placebo-treated patients were akathisia (5% and 1%, respectively) and tremor (2% and 1%, respectively).
Commonly Observed Adverse Reactions
The commonly observed adverse reactions associated with adjunctive aripiprazole and lithium or valproate in patients with Bipolar Mania (incidence of 5% or greater and incidence at least twice that for adjunctive placebo) were: akathisia, insomnia, and extrapyramidal disorder.
Less Common Adverse Reactions in Adult Patients with Adjunctive Therapy in Bipolar Mania
Table 7 enumerates the incidence, rounded to the nearest percent, of adverse reactions that occurred during acute treatment (up to 6 weeks), including only those reactions that occurred in 2% or more of patients treated with adjunctive aripiprazole (doses of 15 mg/day or 30 mg/day) and lithium or valproate and for which the incidence in patients treated with this combination was greater than the incidence in patients treated with placebo plus lithium or valproate.
Table 7: Adverse Reactions in a Short-Term, Placebo-Controlled Trial of Adjunctive Therapy in Patients with Bipolar Disorder
| System Organ Class Preferred Term | Percentage of Patients Reporting Reactiona | |
| Aripiprazole + Li or Val* (n=253) | Placebo + Li or Val* (n=130) | |
| Gastrointestinal Disorders | ||
| Nausea | 8 | 5 |
| Vomiting | 4 | 0 |
| Salivary Hypersecretion | 4 | 2 |
| Dry Mouth | 2 | 1 |
| Infections and Infestations | ||
| Nasopharyngitis | 3 | 2 |
| Investigations | ||
| Weight Increased | 2 | 1 |
| Nervous System Disorders | ||
| Akathisia | 19 | 5 |
| Tremor | 9 | 6 |
| Extrapyramidal Disorder | 5 | 1 |
| Dizziness | 4 | 1 |
| Sedation | 4 | 2 |
| Psychiatric Disorders | ||
| Insomnia | 8 | 4 |
| Anxiety | 4 | 1 |
| Restlessness | 2 | 1 |
| a Adverse reactions reported by at least 2% of patients treated with oral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. * Lithium or Valproate | ||
Pediatric Patients (13 to 17 years) with Schizophrenia
The following findings are based on one 6-week placebo-controlled trial in which oral aripiprazole was administered in doses ranging from 2 mg/day to 30 mg/day.
Adverse Reactions Associated with Discontinuation of Treatment
The incidence of discontinuation due to adverse reactions between aripiprazole-treated and placebo-treated pediatric patients (13 to 17 years) was 5% and 2%, respectively.
Commonly Observed Adverse Reactions
Commonly observed adverse reactions associated with the use of aripiprazole in adolescent patients with Schizophrenia (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) were extrapyramidal disorder, somnolence, and tremor.
Pediatric Patients (10 to 17 years) with Bipolar Mania
The following findings are based on one 4-week placebo-controlled trial in which oral aripiprazole was administered in doses of 10 mg/day or 30 mg/day.
Adverse Reactions Associated with Discontinuation of Treatment
The incidence of discontinuation due to adverse reactions between aripiprazole-treated and placebo-treated pediatric patients (10 to 17 years) was 7% and 2%, respectively.
Commonly Observed Adverse Reactions
Commonly observed adverse reactions associated with the use of aripiprazole in pediatric patients with Bipolar Mania (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) are shown in Table 8.
Table 8: Commonly Observed Adverse Reactions in Short-Term, Placebo-Controlled Trials of Pediatric Patients (10 to 17 years) with Bipolar Mania Treated with Oral ABILIFY
| Preferred Term | Percentage of Patients Reporting Reaction | |
| Aripiprazole (n=197) | Placebo (n=97) | |
| Somnolence | 23 | 3 |
| Extrapyramidal Disorder | 20 | 3 |
| Fatigue | 11 | 4 |
| Nausea | 11 | 4 |
| Akathisia | 10 | 2 |
| Blurred Vision | 8 | 0 |
| Salivary Hypersecretion | 6 | 0 |
| Dizziness | 5 | 1 |
Less Common Adverse Reactions in Pediatric Patients (10 to 17 years) with Schizophrenia or Bipolar Mania
Table 9 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks in Schizophrenia and up to 4 weeks in Bipolar Mania), including only those reactions that occurred in 1% or more of pediatric patients treated with aripiprazole (doses ≥ 2 mg/day) and for which the incidence in patients treated with aripiprazole was greater than the incidence in patients treated with placebo.
Table 9: Adverse Reactions in Short-Term, Placebo-Controlled Trials of Pediatric Patients (10 to 17 years) Treated with Oral ABILIFY
| System Organ Class Preferred Term | Percentage of Patients Reporting Reactiona | |
| Aripiprazole (n=399) | Placebo (n=197) | |
| Eye Disorders | ||
| Blurred Vision | 5 | 0 |
| Gastrointestinal Disorders | ||
| Nausea | 10 | 5 |
| Salivary Hypersecretion | 4 | 1 |
| Diarrhea | 3 | 0 |
| Stomach Discomfort | 2 | 1 |
| Dry Mouth | 2 | 1 |
| General Disorders and Administration Site Conditions | ||
| Fatigue | 7 | 3 |
| Pyrexia | 3 | 1 |
| Infections and Infestations | ||
| Nasopharyngitis | 4 | 3 |
| Investigations | ||
| Weight Increased | 3 | 1 |
| Metabolism and Nutrition Disorders | ||
| Increased Appetite | 4 | 2 |
| Musculoskeletal and Connective Tissue Disorders | ||
| Arthralgia | 2 | 0 |
| Nervous System Disorders | ||
| Somnolence | 20 | 5 |
| Extrapyramidal Disorder | 19 | 4 |
| Headache | 16 | 13 |
| Akathisia | 9 | 4 |
| Dizziness | 5 | 2 |
| Tremor | 5 | 2 |
| Dystonia | 2 | 0 |
| Dyskinesia | 1 | 0 |
| Sedation | 1 | 0 |
| Skin and Subcutaneous Disorders | ||
| Rash | 2 | 1 |
| Vascular Disorders | ||
| Orthostatic Hypotension | 1 | 0 |
| a Adverse reactions reported by at least 1% of pediatric patients treated with oral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. | ||
Adult Patients Receiving ABILIFY as Adjunctive Treatment of Major Depressive Disorder
The following findings are based on a pool of two placebo-controlled trials of patients with Major Depressive Disorder in which aripiprazole was administered at doses of 2 mg to 20 mg as adjunctive treatment to continued antidepressant therapy.
Adverse Reactions Associated with Discontinuation of Treatment
The incidence of discontinuation due to adverse reactions was 6% for adjunctive aripiprazole-treated patients and 2% for adjunctive placebo-treated patients.
Commonly Observed Adverse Reactions
The commonly observed adverse reactions associated with the use of adjunctive aripiprazole in patients with Major Depressive Disorder (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) were: akathisia, restlessness, insomnia, constipation, fatigue, and blurred vision.
Less Common Adverse Reactions in Adult Patients with Major Depressive Disorder
Table 10 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks), including only those adverse reactions that occurred in 2% or more of patients treated with adjunctive aripiprazole (doses ≥ 2 mg/day) and for which the incidence in patients treated with adjunctive aripiprazole was greater than the incidence in patients treated with adjunctive placebo in the combined dataset.
Table 10: Adverse Reactions in Short-Term, Placebo-Controlled Adjunctive Trials in Patients with Major Depressive Disorder
| System Organ Class Preferred Term | Percentage of Patients Reporting Reactiona | |
| Aripiprazole+ADT* (n=371) | Placebo+ADT* (n=366) | |
| Eye Disorders | ||
| Blurred Vision | 6 | 1 |
| Gastrointestinal Disorders | ||
| Constipation | 5 | 2 |
| General Disorders and Administration Site Conditions | ||
| Fatigue | 8 | 4 |
| Feeling Jittery | 3 | 1 |
| Infections and Infestations | ||
| Upper Respiratory Tract Infection | 6 | 4 |
| Investigations | ||
| Weight Increased | 3 | 2 |
| Metabolism and Nutrition Disorders | ||
| Increased Appetite | 3 | 2 |
| Musculoskeletal and Connective Tissue Disorders | ||
| Arthralgia | 4 | 3 |
| Myalgia | 3 | 1 |
| Nervous System Disorders | ||
| Akathisia | 25 | 4 |
| Somnolence | 6 | 4 |
| Tremor | 5 | 4 |
| Sedation | 4 | 2 |
| Dizziness | 4 | 2 |
| Disturbance in Attention | 3 | 1 |
| Extrapyramidal Disorder | 2 | 0 |
| Psychiatric Disorders | ||
| Restlessness | 12 | 2 |
| Insomnia | 8 | 2 |
| a Adverse reactions reported by at least 2% of patients treated with adjunctive aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. * Antidepressant Therapy | ||
Patients with Agitation Associated with Schizophrenia or Bipolar Mania (Intramuscular Injection)
The following findings are based on a pool of three placebo-controlled trials of patients with agitation associated with Schizophrenia or Bipolar Mania in which aripiprazole injection was administered at doses of 5.25 mg to 15 mg.
Adverse Reactions Associated with Discontinuation of Treatment
Overall, in patients with agitation associated with Schizophrenia or Bipolar Mania, there was little difference in the incidence of discontinuation due to adverse reactions between aripiprazole-treated (0.8%) and placebo-treated (0.5%) patients.
Commonly Observed Adverse Reactions
There was one commonly observed adverse reaction (nausea) associated with the use of aripiprazole injection in patients with agitation associated with Schizophrenia and Bipolar Mania (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo).
Less Common Adverse Reactions in Patients with Agitation Associated with Schizophrenia or Bipolar Mania
Table 11 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (24-hour), including only those adverse reactions that occurred in 2% or more of patients treated with aripiprazole injection (doses ≥ 5.25 mg/day) and for which the incidence in patients treated with aripiprazole injection was greater than the incidence in patients treated with placebo in the combined dataset.
Table 11: Adverse Reactions in Short-Term, Placebo-Controlled Trials in Patients Treated with ABILIFY Injection
| System Organ Class Preferred Term | Percentage of Patients Reporting Reactiona | |
| Aripiprazole (n=501) | Placebo (n=220) | |
| Cardiac Disorders | ||
| Tachycardia | 2 | <> |
| Gastrointestinal Disorders | ||
| Nausea | 9 | 3 |
| Vomiting | 3 | 1 |
| General Disorders and Administration Site Conditions | ||
| Fatigue | 2 | 1 |
| Nervous System Disorders | ||
| Headache | 12 | 7 |
| Dizziness | 8 | 5 |
| Somnolence | 7 | 4 |
| Sedation | 3 | 2 |
| Akathisia | 2 | 0 |
| a Adverse reactions reported by at least 2% of patients treated with aripiprazole injection, except adverse reactions which had an incidence equal to or less than placebo. | ||
Dose-Related Adverse Reactions
Schizophrenia
Dose response relationships for the incidence of treatment-emergent adverse events were evaluated from four trials in adult patients with Schizophrenia comparing various fixed doses (2 mg/day, 5 mg/day, 10 mg/day, 15 mg/day, 20 mg/day, and 30 mg/day) of oral aripiprazole to placebo. This analysis, stratified by study, indicated that the only adverse reaction to have a possible dose response relationship, and then most prominent only with 30 mg, was somnolence [including sedation]; (incidences were placebo, 7.1%; 10 mg, 8.5%; 15 mg, 8.7%; 20 mg, 7.5%; 30 mg, 12.6%).
In the study of pediatric patients (13 to 17 years of age) with Schizophrenia, three common adverse reactions appeared to have a possible dose response relationship: extrapyramidal disorder (incidences were placebo, 5.0%; 10 mg, 13.0%; 30 mg, 21.6%); somnolence (incidences were placebo, 6.0%; 10 mg, 11.0%; 30 mg, 21.6%); and tremor (incidences were placebo, 2.0%; 10 mg, 2.0%; 30 mg, 11.8%).
Bipolar Mania
In the study of pediatric patients (10 to 17 years of age) with Bipolar Mania, four common adverse reactions had a possible dose response relationship at 4 weeks; extrapyramidal disorder (incidences were placebo, 3.1%; 10 mg, 12.2%; 30 mg, 27.3%); somnolence (incidences were placebo, 3.1%; 10 mg, 19.4%; 30 mg, 26.3%); akathisia (incidences were placebo, 2.1%; 10 mg, 8.2%; 30 mg, 11.1%); and salivary hypersecretion (incidences were placebo, 0%; 10 mg, 3.1%; 30 mg, 8.1%).
Extrapyramidal Symptoms
In short-term, placebo-controlled trials in Schizophrenia in adults, the incidence of reported EPS-related events, excluding events related to akathisia, for aripiprazole-treated patients was 13% vs. 12% for placebo; and the incidence of akathisia-related events for aripiprazole-treated patients was 8% vs. 4% for placebo. In the short-term, placebo-controlled trial of Schizophrenia in pediatric (13 to 17 years) patients, the incidence of reported EPS-related events, excluding events related to akathisia, for aripiprazole-treated patients was 25% vs. 7% for placebo; and the incidence of akathisia-related events for aripiprazole-treated patients was 9% vs. 6% for placebo. In the short-term, placebo-controlled trials in Bipolar Mania in adults, the incidence of reported EPS-related events, excluding events related to akathisia, for monotherapy aripiprazole-treated patients was 16% vs. 8% for placebo and the incidence of akathisia-related events for monotherapy aripiprazole-treated patients was 13% vs. 4% for placebo. In the 6-week, placebo-controlled trial in Bipolar Mania for adjunctive therapy with lithium or valproate, the incidence of reported EPS-related events, excluding events related to akathisia for adjunctive aripiprazole-treated patients was 15% vs. 8% for adjunctive placebo and the incidence of akathisia-related events for adjunctive aripiprazole-treated patients was 19% vs. 5% for adjunctive placebo. In the short-term, placebo-controlled trial in Bipolar Mania in pediatric (10 to 17 years) patients, the incidence of reported EPS-related events, excluding events related to akathisia, for aripiprazole-treated patients was 26% vs. 5% for placebo and the incidence of akathisia-related events for aripiprazole-treated patients was 10% vs. 2% for placebo. In the short-term, placebo-controlled trials in Major Depressive Disorder, the incidence of reported EPS-related events, excluding events related to akathisia, for adjunctive aripiprazole-treated patients was 8% vs. 5% for adjunctive placebo-treated patients; and the incidence of akathisia-related events for adjunctive aripiprazole-treated patients was 25% vs. 4% for adjunctive placebo-treated patients.
Objectively collected data from those trials was collected on the Simpson Angus Rating Scale (for EPS), the Barnes Akathisia Scale (for akathisia), and the Assessments of Involuntary Movement Scales (for dyskinesias). In the adult Schizophrenia trials, the objectively collected data did not show a difference between aripiprazole and placebo, with the exception of the Barnes Akathisia Scale (aripiprazole, 0.08; placebo, -0.05). In the pediatric (13 to 17 years) Schizophrenia trial, the objectively collected data did not show a difference between aripiprazole and placebo, with the exception of the Simpson Angus Rating Scale (aripiprazole, 0.24; placebo, -0.29). In the adult Bipolar Mania trials with monotherapy aripiprazole, the Simpson Angus Rating Scale and the Barnes Akathisia Scale showed a significant difference between aripiprazole and placebo (aripiprazole, 0.50; placebo, -0.01 and aripiprazole, 0.21; placebo, -0.05). Changes in the Assessments of Involuntary Movement Scales were similar for the aripiprazole and placebo groups. In the Bipolar Mania trials with aripiprazole as adjunctive therapy with either lithium or valproate, the Simpson Angus Rating Scale and the Barnes Akathisia Scale showed a significant difference between adjunctive aripiprazole and adjunctive placebo (aripiprazole, 0.73; placebo, 0.07 and aripiprazole, 0.30; placebo, 0.11). Changes in the Assessments of Involuntary Movement Scales were similar for adjunctive aripiprazole and adjunctive placebo. In the pediatric (10 to 17 years) short-term Bipolar Mania trial, the Simpson Angus Rating Scale showed a significant difference between aripiprazole and placebo (aripiprazole, 0.90; placebo, -0.05). Changes in the Barnes Akathisia Scale and the Assessments of Involuntary Movement Scales were similar for the aripiprazole and placebo groups. In the Major Depressive Disorder trials, the Simpson Angus Rating Scale and the Barnes Akathisia Scale showed a significant difference between adjunctive aripiprazole and adjunctive placebo (aripiprazole, 0.31; placebo, 0.03 and aripiprazole, 0.22; placebo, 0.02). Changes in the Assessments of Involuntary Movement Scales were similar for the adjunctive aripiprazole and adjunctive placebo groups.
Similarly, in a long-term (26-week), placebo-controlled trial of Schizophrenia in adults, objectively collected data on the Simpson Angus Rating Scale (for EPS), the Barnes Akathisia Scale (for akathisia), and the Assessments of Involuntary Movement Scales (for dyskinesias) did not show a difference between aripiprazole and placebo.
In the placebo-controlled trials in patients with agitation associated with Schizophrenia or Bipolar Mania, the incidence of reported EPS-related events excluding events related to akathisia for aripiprazole-treated patients was 2% vs. 2% for placebo and the incidence of akathisia-related events for aripiprazole-treated patients was 2% vs. 0% for placebo. Objectively collected data on the Simpson Angus Rating Scale (for EPS) and the Barnes Akathisia Scale (for akathisia) for all treatment groups did not show a difference between aripiprazole and placebo.
Dystonia
Class Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.
Laboratory Test Abnormalities
A between group comparison for 3-week to 6-week, placebo-controlled trials in adults or 4-week to 6-week, placebo-controlled trials in pediatric patients (10 to 17 years) revealed no medically important differences between the aripiprazole and placebo groups in the proportions of patients experiencing potentially clinically significant changes in routine serum chemistry, hematology, or urinalysis parameters. Similarly, there were no aripiprazole/placebo differences in the incidence of discontinuations for changes in serum chemistry, hematology, or urinalysis in adult or pediatric patients.
In the 6-week trials of aripiprazole as adjunctive therapy for Major Depressive Disorder, there were no clinically important differences between the adjunctive aripiprazole-treated and adjunctive placebo-treated patients in the median change from baseline in prolactin, fasting glucose, HDL, LDL, or total cholesterol measurements. The median % change from baseline in triglycerides was 5% for adjunctive aripiprazole-treated patients vs. 0% for adjunctive placebo-treated patients.
In a long-term (26-week), placebo-controlled trial there were no medically important differences between the aripiprazole and placebo patients in the mean change from baseline in prolactin, fasting glucose, triglyceride, HDL, LDL, or total cholesterol measurements.
Weight Gain
In 4-week to 6-week trials in adults with Schizophrenia, there was a slight difference in mean weight gain between aripiprazole and placebo patients (+0.7 kg vs. -0.05 kg, respectively) and also a difference in the proportion of patients meeting a weight gain criterion of ≥ 7% of body weight [aripiprazole (8%) compared to placebo (3%)]. In a 6-week trial in pediatric patients (13 to 17 years) with Schizophrenia, there was a slight difference in mean weight gain between aripiprazole and placebo patients (+0.13 kg vs. -0.83 kg, respectively) and also a difference in the proportion of patients meeting a weight gain criterion of ≥ 7% of body weight [aripiprazole (5%) compared to placebo (1%)]. In 3-week trials in adults with Mania with monotherapy aripiprazole, the mean weight gain for aripiprazole and placebo patients was 0.1 kg vs. 0.0 kg, respectively. The proportion of patients meeting a weight gain criterion of ≥ 7% of body weight was aripiprazole (2%) compared to placebo (3%). In the 6-week trial in Mania with aripiprazole as adjunctive therapy with either lithium or valproate, the mean weight gain for aripiprazole and placebo patients was 0.6 kg vs. 0.2 kg, respectively. The proportion of patients meeting a weight gain criterion of ≥ 7% of body weight with adjunctive aripiprazole was 3% compared to adjunctive placebo 4%.
In the trials adding aripiprazole to antidepressants, patients first received 8 weeks of antidepressant treatment followed by 6 weeks of adjunctive aripiprazole or placebo in addition to their ongoing antidepressant treatment. The mean weight gain with adjunctive aripiprazole was 1.7 kg vs. 0.4 kg with adjunctive placebo. The proportion of patients meeting a weight gain criterion of ≥ 7% of body weight was 5% with adjunctive aripiprazole compared to 1% with adjunctive placebo.
Table 12 provides the weight change results from a long-term (26-week), placebo-controlled study of aripiprazole, both mean change from baseline and proportions of patients meeting a weight gain criterion of ≥ 7% of body weight relative to baseline, categorized by BMI at baseline. Although there was no mean weight increase, the aripiprazole group tended to show more patients with a ≥ 7% weight gain.
Table 12: Weight Change Results Categorized by BMI at Baseline: Placebo-Controlled Study in Schizophrenia, Safety Sample
| BMI <> | BMI 23-27 | BMI > 27 | ||||
| Placebo (n=54) | Aripiprazole (n=59) | Placebo (n=48) | Aripiprazole (n=39) | Placebo (n=49) | Aripiprazole (n=53) | |
| Mean change from baseline (kg) | -0.5 | -0.5 | -0.6 | -1.3 | -1.5 | -2.1 |
| % with ≥ 7% increase BW | 3.7% | 6.8% | 4.2% | 5.1% | 4.1% | 5.7% |
Table 13 provides the weight change results from a long-term (52-week) study of aripiprazole, both mean change from baseline and proportions of patients meeting a weight gain criterion of ≥ 7% of body weight relative to baseline, categorized by BMI at baseline:
Table 13: Weight Change Results Categorized by BMI at Baseline: Active-Controlled Study in Schizophrenia, Safety Sample
| BMI < 23 (n=314) | BMI 23-27 (n=265) | BMI > 27 (n=260) | |
| Mean change from baseline (kg) | 2.6 | 1.4 | -1.2 |
| % with ≥ 7% increase BW | 30% | 19% | 8% |
ECG Changes
Between group comparisons for a pooled analysis of placebo-controlled trials in patients with Schizophrenia, Bipolar Mania, or Major Depressive Disorder revealed no significant differences between oral aripiprazole and placebo in the proportion of patients experiencing potentially important changes in ECG parameters. Aripiprazole was associated with a median increase in heart rate of 2 beats per minute compared to no increase among placebo patients.
In the pooled, placebo-controlled trials in patients with agitation associated with Schizophrenia or Bipolar Mania, there were no significant differences between aripiprazole injection and placebo in the proportion of patients experiencing potentially important changes in ECG parameters, as measured by standard 12-lead ECGs.
Additional Findings Observed in Clinical Trials
Adverse Reactions in Long-Term, Double-Blind, Placebo-Controlled Trials
The adverse reactions reported in a 26-week, double-blind trial comparing oral ABILIFY and placebo in patients with Schizophrenia were generally consistent with those reported in the short-term, placebo-controlled trials, except for a higher incidence of tremor [8% (12/153) for ABILIFY vs. 2% (3/153) for placebo]. In this study, the majority of the cases of tremor were of mild intensity (8/12 mild and 4/12 moderate), occurred early in therapy (9/12 ≤ 49 days), and were of limited duration (7/12 ≤ 10 days). Tremor infrequently led to discontinuation ( <>
Other Adverse Reactions Observed During the Premarketing Evaluation of Aripiprazole
Following is a list of MedDRA terms that reflect adverse reactions as defined in ADVERSE REACTIONS reported by patients treated with oral aripiprazole at multiple doses ≥ 2 mg/day during any phase of a trial within the database of 13,543 adult patients. All events assessed as possible adverse drug reactions have been included with the exception of more commonly occurring events. In addition, medically/clinically meaningful adverse reactions, particularly those that are likely to be useful to the prescriber or that have pharmacologic plausibility, have been included. Events already listed in other parts of ADVERSE REACTIONS, or those considered in WARNINGS AND PRECAUTIONS or OVERDOSAGE have been excluded. Although the reactions reported occurred during treatment with aripiprazole, they were not necessarily caused by it.
Events are further categorized by MedDRA system organ class and listed in order of decreasing frequency according to the following definitions: those occurring in at least 1/100 patients (only those not already listed in the tabulated results from placebo-controlled trials appear in this listing); those occurring in 1/100 to 1/1000 patients; and those occurring in fewer than 1/1000 patients.
Adults - Oral Administration
Blood and Lymphatic System Disorders: ≥ 1/1000 patients and <>
Cardiac Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=4741">palpitations, cardiopulmonary failure, myocardial infarction, cardio-respiratory arrest, atrioventricular block, extrasystoles, sinus tachycardia, atrial fibrillation, angina pectoris, myocardial ischemia; < href="http://www.rxlist.com/script/main/art.asp?articlekey=9739">atrial flutter, supraventricular tachycardia, ventricular tachycardia
Eye Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=4882">photophobia, diplopia, eyelid edema, photopsia
Gastrointestinal Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=3322">esophagitis; < href="http://www.rxlist.com/script/main/art.asp?articlekey=4745">pancreatitis
General Disorders and Administration Site Conditions: ≥ 1/100 patients - asthenia, peripheral edema, irritability, chest pain; ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=2253">angioedema; <>
Hepatobiliary Disorders: < href="http://www.rxlist.com/script/main/art.asp?articlekey=4070">jaundice
Immune System Disorders: ≥ 1/1000 patients and <>
Injury, Poisoning, and Procedural Complications: ≥ 1/100 patients - fall; ≥ 1/1000 patients and <>
Investigations: ≥ 1/100 patients - weight decreased, creatine phosphokinase increased; ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=32858">blood glucose increased, blood prolactin increased, blood urea increased, electrocardiogram QT prolonged, blood creatinine increased, blood bilirubin increased; < href="http://www.rxlist.com/script/main/art.asp?articlekey=16295">glycosylated hemoglobin increased, gammaglutamyl transferase increased
Metabolism and Nutrition Disorders: ≥ 1/100 patients - decreased appetite; ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=2268">anorexia, diabetes mellitus (including blood insulin increased, carbohydrate tolerance decreased, diabetes mellitus non-insulin-dependent, glucose tolerance impaired, glycosuria, glucose urine, glucose urine present), hyperglycemia, hypokalemia, hyponatremia, hypoglycemia, polydipsia; <>
Musculoskeletal and Connective Tissue Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=5352"> rhabdomyolysis
Nervous System Disorders: ≥ 1/100 patients - coordination abnormal; ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=25850">parkinsonism, memory impairment, cogwheel rigidity, cerebrovascular accident, hypokinesia, tardive dyskinesia, hypotonia, myoclonus, hypertonia, akinesia, bradykinesia; <>
Psychiatric Disorders: ≥ 1/100 patients - suicidal ideation; ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=25392"> anorgasmia, delirium, intentional self injury, completed suicide, tic, homicidal ideation; <>
Renal and Urinary Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=16279">polyuria, nocturia
Reproductive System and Breast Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=4355">menstruation irregular, erectile dysfunction, amenorrhea, breast pain; < href="http://www.rxlist.com/script/main/art.asp?articlekey=5040">priapism
Respiratory, Thoracic, and Mediastinal Disorders: ≥ 1/100 patients - nasal congestion, dyspnea, pneumonia aspiration
Skin and Subcutaneous Tissue Disorders: ≥ 1/100 patients - rash (including erythematous, exfoliative, generalized, macular, maculopapular, papular rash; acneiform, allergic, contact, exfoliative, seborrheic dermatitis, neurodermatitis, and drug eruption), hyperhydrosis; ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=5095">pruritus, photosensitivity reaction, alopecia, urticaria
Vascular Disorders: ≥ 1/100 patients -hypertension; ≥ 1/1000 patients and <>
Pediatric Patients - Oral Administration
Most adverse events observed in the pooled database of 514 pediatric patients aged 10 to 17 years were also observed in the adult population. Additional adverse reactions observed in the pediatric population are listed below.
Gastrointestinal Disorders: ≥ 1/1000 patients and <>
Investigations: ≥ 1/100 patients -blood insulin increased
Nervous System Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=19670">sleep talking
Skin and Subcutaneous Tissue Disorders: ≥ 1/1000 patients and < href="http://www.rxlist.com/script/main/art.asp?articlekey=3761">hirsutism
Adults - Intramuscular Injection
All adverse reactions observed in the pooled database of 749 adult patients treated with aripiprazole injection, were also observed in the adult population treated with oral aripiprazole. Additional adverse reactions observed in the aripiprazole injection population are listed below.
General Disorders and Administration Site Conditions: ≥ 1/100 patients -injection site reaction; ≥ 1/1000 patients and <>
Postmarketing Experience
The following adverse reactions have been identified during postapproval use of ABILIFY. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to establish a causal relationship to drug exposure: rare occurrences of allergic reaction (anaphylactic reaction, angioedema, laryngospasm, pruritus/urticaria, or oropharyngeal spasm), and blood glucose fluctuation.
DRUG INTERACTIONS
Given the primary CNS effects of aripiprazole, caution should be used when ABILIFY is taken in combination with other centrally-acting drugs or alcohol.
Due to its alpha adrenergic antagonism, aripiprazole has the potential to enhance the effect of certain antihypertensive agents.
Potential for Other Drugs to Affect ABILIFY
Aripiprazole is not a substrate of CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, or CYP2E1 enzymes. Aripiprazole also does not undergo direct glucuronidation. This suggests that an interaction of aripiprazole with inhibitors or inducers of these enzymes, or other factors, like smoking, is unlikely.
Both CYP3A4 and CYP2D6 are responsible for aripiprazole metabolism. Agents that induce CYP3A4 (eg, carbamazepine) could cause an increase in aripiprazole clearance and lower blood levels. Inhibitors of CYP3A4 (eg, ketoconazole) or CYP2D6 (eg, quinidine, fluoxetine, or paroxetine) can inhibit aripiprazole elimination and cause increased blood levels.
Ketoconazole and Other CYP3A4 Inhibitors
Coadministration of ketoconazole (200 mg/day for 14 days) with a 15 mg single dose of aripiprazole increased the AUC of aripiprazole and its active metabolite by 63% and 77%, respectively. The effect of a higher ketoconazole dose (400 mg/day) has not been studied. When ketoconazole is given concomitantly with aripiprazole, the aripiprazole dose should be reduced to one-half of its normal dose. Other strong inhibitors of CYP3A4 (itraconazole) would be expected to have similar effects and need similar dose reductions; moderate inhibitors (erythromycin, grapefruit juice) have not been studied. When the CYP3A4 inhibitor is withdrawn from the combination therapy, the aripiprazole dose should be increased.
Quinidine and Other CYP2D6 Inhibitors
Coadministration of a 10 mg single dose of aripiprazole with quinidine (166 mg/day for 13 days), a potent inhibitor of CYP2D6, increased the AUC of aripiprazole by 112% but decreased the AUC of its active metabolite, dehydro-aripiprazole, by 35%. Aripiprazole dose should be reduced to one-half of its normal dose when quinidine is given concomitantly with aripiprazole. Other significant inhibitors of CYP2D6, such as fluoxetine or paroxetine, would be expected to have similar effects and should lead to similar dose reductions. When the CYP2D6 inhibitor is withdrawn from the combination therapy, the aripiprazole dose should be increased. When adjunctive ABILIFY is administered to patients with Major Depressive Disorder, ABILIFY should be administered without dosage adjustment as specified in DOSAGE AND ADMINISTRATION.
Carbamazepine and Other CYP3A4 Inducers
Coadministration of carbamazepine (200 mg twice daily), a potent CYP3A4 inducer, with aripiprazole (30 mg/day) resulted in an approximate 70% decrease in Cmax and AUC values of both aripiprazole and its active metabolite, dehydro-aripiprazole. When carbamazepine is added to aripiprazole therapy, aripiprazole dose should be doubled. Additional dose increases should be based on clinical evaluation. When carbamazepine is withdrawn from the combination therapy, the aripiprazole dose should be reduced.
Potential for ABILIFY to Affect Other Drugs
Aripiprazole is unlikely to cause clinically important pharmacokinetic interactions with drugs metabolized by cytochrome P450 enzymes. In in vivo studies, 10 mg/day to 30 mg/day doses of aripiprazole had no significant effect on metabolism by CYP2D6 (dextromethorphan), CYP2C9 (warfarin), CYP2C19 (omeprazole, warfarin), and CYP3A4 (dextromethorphan) substrates. Additionally, aripiprazole and dehydroaripiprazole did not show potential for altering CYP1A2-mediated metabolism in vitro.
No effect of aripiprazole was seen on the pharmacokinetics of lithium or valproate.
Alcohol
There was no significant difference between aripiprazole coadministered with ethanol and placebo coadministered with ethanol on performance of gross motor skills or stimulus response in healthy subjects. As with most psychoactive medications, patients should be advised to avoid alcohol while taking ABILIFY.
Drugs Having No Clinically Important Interactions with ABILIFY
Famotidine
Coadministration of aripiprazole (given in a single dose of 15 mg) with a 40 mg single dose of the H2antagonist famotidine, a potent gastric acid blocker, decreased the solubility of aripiprazole and, hence, its rate of absorption, reducing by 37% and 21% the Cmax of aripiprazole and dehydro-aripiprazole, respectively, and by 13% and 15%, respectively, the extent of absorption (AUC). No dosage adjustment of aripiprazole is required when administered concomitantly with famotidine.
Valproate
When valproate (500 mg/day-1500 mg/day) and aripiprazole (30 mg/day) were coadministered, at steady-state the Cmax and AUC of aripiprazole were decreased by 25%. No dosage adjustment of aripiprazole is required when administered concomitantly with valproate.
When aripiprazole (30 mg/day) and valproate (1000 mg/day) were coadministered, at steady-state there were no clinically significant changes in the Cmax or AUC of valproate. No dosage adjustment of valproate is required when administered concomitantly with aripiprazole.
Lithium
A pharmacokinetic interaction of aripiprazole with lithium is unlikely because lithium is not bound to plasma proteins, is not metabolized, and is almost entirely excreted unchanged in urine. Coadministration of therapeutic doses of lithium (1200 mg/day1800 mg/day) for 21 days with aripiprazole (30 mg/day) did not result in clinically significant changes in the pharmacokinetics of aripiprazole or its active metabolite, dehydro-aripiprazole (Cmax and AUC increased by less than 20%). No dosage adjustment of aripiprazole is required when administered concomitantly with lithium.
Coadministration of aripiprazole (30 mg/day) with lithium (900 mg/day) did not result in clinically significant changes in the pharmacokinetics of lithium. No dosage adjustment of lithium is required when administered concomitantly with aripiprazole.
Lamotrigine
Coadministration of 10 mg/day to 30 mg/day oral doses of aripiprazole for 14 days to patients with Bipolar I Disorder had no effect on the steady-state pharmacokinetics of 100 mg/day to 400 mg/day lamotrigine, a UDP-glucuronosyltransferase 1A4 substrate. No dosage adjustment of lamotrigine is required when aripiprazole is added to lamotrigine.
Dextromethorphan
Aripiprazole at doses of 10 mg/day to 30 mg/day for 14 days had no effect on dextromethorphan's O-dealkylation to its major metabolite, dextrorphan, a pathway dependent on CYP2D6 activity. Aripiprazole also had no effect on dextromethorphan's N-demethylation to its metabolite 3-methoxymorphinan, a pathway dependent on CYP3A4 activity. No dosage adjustment of dextromethorphan is required when administered concomitantly with aripiprazole.
Warfarin
Aripiprazole 10 mg/day for 14 days had no effect on the pharmacokinetics of R-warfarin and S-warfarin or on the pharmacodynamic end point of International Normalized Ratio, indicating the lack of a clinically relevant effect of aripiprazole on CYP2C9 and CYP2C19 metabolism or the binding of highly protein-bound warfarin. No dosage adjustment of warfarin is required when administered concomitantly with aripiprazole.
Omeprazole
Aripiprazole 10 mg/day for 15 days had no effect on the pharmacokinetics of a single 20 mg dose of omeprazole, a CYP2C19 substrate, in healthy subjects. No dosage adjustment of omeprazole is required when administered concomitantly with aripiprazole.
Lorazepam
Coadministration of lorazepam injection (2 mg) and aripiprazole injection (15 mg) to healthy subjects (n=40: 35 males and 5 females; ages 19-45 years old) did not result in clinically important changes in the pharmacokinetics of either drug. No dosage adjustment of aripiprazole is required when administered concomitantly with lorazepam. However, the intensity of sedation was greater with the combination as compared to that observed with aripiprazole alone and the orthostatic hypotension observed was greater with the combination as compared to that observed with lorazepam alone [see WARNINGS AND PRECAUTIONS].
Escitalopram
Coadministration of 10 mg/day oral doses of aripiprazole for 14 days to healthy subjects had no effect on the steady-state pharmacokinetics of 10 mg/day escitalopram, a substrate of CYP2C19 and CYP3A4. No dosage adjustment of escitalopram is required when aripiprazole is added to escitalopram.
Venlafaxine
Coadministration of 10 mg/day to 20 mg/day oral doses of aripiprazole for 14 days to healthy subjects had no effect on the steady-state pharmacokinetics of venlafaxine and O-desmethylvenlafaxine following 75 mg/day venlafaxine XR, a CYP2D6 substrate. No dosage adjustment of venlafaxine is required when aripiprazole is added to venlafaxine.
Fluoxetine, Paroxetine, and Sertraline
A population pharmacokinetic analysis in patients with Major Depressive Disorder showed no substantial change in plasma concentrations of fluoxetine (20 mg/day or 40 mg/day), paroxetine CR (37.5 mg/day or 50 mg/day), or sertraline (100 mg/day or 150 mg/day) dosed to steady-state. The steady-state plasma concentrations of fluoxetine and norfluoxetine increased by about 18% and 36%, respectively and concentrations of paroxetine decreased by about 27%. The steady-state plasma concentrations of sertraline and desmethylsertraline were not substantially changed when these antidepressant therapies were coadministered with aripiprazole. Aripiprazole dosing was 2 mg/day to 15 mg/day (when given with fluoxetine or paroxetine) or 2 mg/day to 20 mg/day (when given with sertraline).
Drug Abuse And Dependence
Controlled Substance
ABILIFY is not a controlled substance.
Abuse and Dependence
Aripiprazole has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence. In physical dependence studies in monkeys, withdrawal symptoms were observed upon abrupt cessation of dosing. While the clinical trials did not reveal any tendency for any drug-seeking behavior, these observations were not systematic and it is not possible to predict on the basis of this limited experience the extent to which a CNS-active drug will be misused, diverted, and/or abused once marketed. Consequently, patients should be evaluated carefully for a history of drug abuse, and such patients should be observed closely for signs of ABILIFY misuse or abuse (eg, development of tolerance, increases in dose, drug-seeking behavior).
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