Side effects of abilify

Are you currently using Abilify?

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking aripiprazole and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually once daily. The dosage is based on your medical condition, response to treatment, age, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

The manufacturer directs to swallow this medication whole. However, many similar drugs (immediate-release tablets) can be split/crushed. Follow your doctor’s direction on how to take this medication.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/cup. Do not use a household spoon because you may not get the correct dose.

Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

It may take several weeks before you get the full benefit of this drug. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

It is important to continue taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your condition does not improve or if it worsens.

“It’s important to recognize that severe mental illnesses, including schizophrenia and bipolar 1 disorder, often strike during adolescence and are devastating,” Mr. Schuler said.

In an editorial accompanying the study in the journal, Dr. Christopher K. Varley and Dr. Jon McClellan, child psychiatrists at Seattle Children’s Hospital and the University of Washington school of medicine, wrote that “ominous long-term health implications” arise from weight gain and changes in blood fat levels early in life. “These results challenge the widespread use of atypical antipsychotic medications in youth,” they wrote.

Dr. Varley said in a phone interview Monday that doctors had been loath to use the older antipsychotic medicines, like Thorazine and Haldol, because of neurological side effects. But he said the new data indicated that the newer ones should be prescribed more cautiously.

“In the course of less than 12 weeks, the weight gains are startling,” he said. “If you look at Zyprexa, the kids are gaining a pound and a half a week. Even with the drug Abilify, which is one that was not so prone to weight gain, kids still gained a pound a week. In addition, they had evidence in a very short period of time of other metabolic problems.”

The study covered 272 patients visiting clinics in Brooklyn, Queens and Long Island from 2001 to 2007. Fifteen patients who stopped taking their medicine were used as a control group. Their weight stayed level. The 257 patients who stayed on their drugs took detailed tests, including a fasting blood test to check for high glucose levels.

Their mean weight at the start of the study period was 118 pounds. But after about 11 weeks, those who took Zyprexa had gained 18.7 pounds; Seroquel, 13.4 pounds; Risperdal, 11.7 pounds; and Abilify, 9.7 pounds.

Their waists typically expanded three inches with Zyprexa, and two inches with the others.

All but Abilify showed rapid and significant increases in one or more metabolic markers, which can presage adult obesity, hypertension and Type 2 diabetes. The metabolic markers included glucose, insulin, triglycerides and cholesterol.

The authors noted that the study had limitations. Patients were not randomly assigned, so the baseline starting weights differed. Clinicians, given the choice, started heavier patients on Seroquel and those with the lowest fat mass on Zyprexa, who then gained the most, the data show. Also, the study did not control for dosing or other medications, which can affect outcome.

Abilify (aripiprazole) Drug Interactions

A total of 637 drugs are known to interact with Abilify (aripiprazole).

  • 33 major drug interactions
  • 599 moderate drug interactions
  • 5 minor drug interactions

Show all medications in the database that may interact with Abilify (aripiprazole).

Check for interactions

Type in a drug name to check for interactions with Abilify (aripiprazole).

Most frequently checked interactions

View interaction reports for Abilify (aripiprazole) and the medicines listed below.

  • Adderall (amphetamine / dextroamphetamine)
  • Ambien (zolpidem)
  • Benadryl (diphenhydramine)
  • Celexa (citalopram)
  • clonazepam
  • Cymbalta (duloxetine)
  • Effexor (venlafaxine)
  • gabapentin
  • Klonopin (clonazepam)
  • Lamictal (lamotrigine)
  • lamotrigine
  • levothyroxine
  • Lexapro (escitalopram)
  • lisinopril
  • metformin
  • omeprazole
  • Pristiq (desvenlafaxine)
  • Prozac (fluoxetine)
  • Seroquel (quetiapine)
  • Topamax (topiramate)
  • trazodone
  • Viibryd (vilazodone)
  • Vitamin D3 (cholecalciferol)
  • Wellbutrin (bupropion)
  • Wellbutrin XL (bupropion)
  • Xanax (alprazolam)
  • Zoloft (sertraline)

Abilify (aripiprazole) alcohol/food interactions

There are 4 alcohol/food interactions with Abilify (aripiprazole)

Abilify (aripiprazole) disease interactions

There are 17 disease interactions with Abilify (aripiprazole) which include:

  • dementia
  • acute alcohol intoxication
  • CNS depression
  • NMS
  • tardive dyskinesia
  • depression
  • aspiration
  • seizure
  • hematologic abnormalities
  • hyperglycemia/diabetes
  • hypotension
  • lipid alterations
  • weight gain
  • anticholinergic effects
  • hyperprolactinemia
  • liver disease
  • parkinsonism

More about Abilify (aripiprazole)

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Patient Tips
  • Drug Images
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • En Español
  • 802 Reviews
  • Generic Availability
  • Drug class: atypical antipsychotics
  • FDA Alerts (5)

Related treatment guides

  • Autism
  • Bipolar Disorder
  • Depression
  • Agitated State
  • … +3 more

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major

Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.

Moderate

Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.

Minor

Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Unknown

No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Does Abilify Interact with other Medications?

Severe Interactions

These medications are not usually taken together. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation.

  • ANTIPSYCHOTICS/SIBUTRAMINE
  • NEUROLEPTICS/IOMEPROL

Serious Interactions

These medications may interact and cause very harmful effects. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation.

  • ANTIPSYCHOTICS; PHENOTHIAZINES/OPIOIDS (COUGH AND COLD)
  • ANTIPSYCHOTICS; PHENOTHIAZINES; RIVASTIGMINE/METOCLOPRAMIDE
  • SELECTED DOPAMINE BLOCKERS/CABERGOLINE

Moderate Interactions

These medications may cause some risk when taken together. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation.

  • ARIPIPRAZOLE/STRONG CYP3A4 INHIBITORS
  • ARIPIPRAZOLE/SELECT STRONG CYP2D6 INHIBITORS
  • SELECTED ANTIPSYCHOTICS/STRONG CYP3A4 INDUCERS
  • ARIPIPRAZOLE/DULOXETINE
  • ARIPIPRAZOLE/BUPROPION
  • SELECTED ANTIPSYCHOTICS; PHENOTHIAZINES/TRAMADOL (IR)
  • SELECTED ANTIPSYCHOTICS; PHENOTHIAZINES/METHADONE (NON MAT)
  • SELECTED ANTIPSYCHOTICS; PHENOTHIAZINES/LEVOMETHADYL (IR)
  • SLT ANTIPSYCHOTICS; PHENOTHIAZINES/CODEINE; LEVORPHANOL (IR)
  • SELECTED ANTIPSYCHOTICS; PHENOTHIAZINES/MEPERIDINE (IR)
  • ANTIPSYCHOTICS/BUPRENORPHINE & METHADONE FOR MAT
  • ANTIPSYCHOTICS;PHENOTHIAZINE/SLT OPIOIDS (IMMEDIATE RELEASE)
  • ANTIPSYCHOTICS; PHENOTHIAZINES/OPIOIDS (EXTENDED RELEASE)
  • SELECT ATYPICAL ANTIPSYCHOTICS/SELECTED DOPAMINE AGONISTS

SIDE EFFECTS: See also Warning section.Dizziness, lightheadedness, drowsiness, nausea, vomiting, tiredness, excess saliva/drooling, blurred vision, weight gain, constipation, headache, and trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, mental/mood changes (such as increased anxiety, depression, suicidal thoughts), trouble swallowing, restlessness (especially in the legs), shaking (tremor), muscle spasm, mask-like expression of the face, seizures, signs of infection (such as fever, persistent sore throat).This medication may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Rarely, very serious conditions such as diabetic coma may occur. Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This medication may rarely cause a condition called tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any unusual uncontrolled movements (especially of the face, mouth, tongue, arms, or legs).This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, change in the amount of urine.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before taking aripiprazole, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as propylene glycol), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: problems with blood flow in the brain (such as cerebrovascular disease, stroke), diabetes (including family history), heart problems (such as low blood pressure, coronary artery disease, heart failure, irregular heartbeat), nervous system problems (such as dementia, NMS, seizures), obesity, low white blood cell count (including history of low white blood cell count caused by medications), swallowing problems.This drug may make you dizzy or drowsy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Avoid alcoholic beverages.This medication can make you more likely to get heat stroke, a very serious condition. Avoid activities that might cause you to overheat (such as doing strenuous work/exercise in hot weather, using hot tubs). When the weather is hot, drink plenty of fluids and dress lightly. If you become overheated, promptly seek cooler shelter and stop exercising.Liquid preparations of this product may contain sugar. Caution is advised if you have diabetes. Ask your doctor or pharmacist about using this product safely.Older adults may be more sensitive to the side effects of this drug, especially seizures, drowsiness, confusion, tardive dyskinesia, swallowing problems, and other serious (rarely fatal) side effects. (See also Warning section.) Drowsiness and confusion can increase the risk of falling.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Do not stop taking this medication unless directed by your doctor. Babies born to mothers who have used this drug during the last 3 months of pregnancy may infrequently develop symptoms including muscle stiffness or shakiness, drowsiness, feeding/breathing difficulties, or constant crying. If you notice any of these symptoms in your newborn anytime during their first month, tell the doctor right away.This medication passes into breast milk. Breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

SLIDESHOW

Learn to Spot Depression: Symptoms, Warning Signs, Medication See Slideshow

Abilify

Generic Name: aripiprazole (AR i PIP ra zole)
Brand Names: Abilify, Abilify Discmelt

Medically reviewed by P. Thornton, DipPharm Last updated on Oct 1, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

What is Abilify?

Abilify (aripiprazole is an antipsychotic medication. It works by changing the actions of chemicals in the brain.

Abilify is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar I disorder (manic depression). It is not known if aripiprazole is safe or effective in children younger than 13 with schizophrenia, or children younger than 10 with bipolar disorder.

Abilify is also used together with other medicines to treat major depressive disorder in adults.

Abilify is also used in children 6 years or older who have Tourette’s disorder, or symptoms of autistic disorder (irritability, aggression, mood swings, temper tantrums, and self-injury).

Important information

Abilify is not approved for use in psychotic conditions related to dementia. Abilify may increase the risk of death in older adults with dementia-related conditions.

Some young people have thoughts about suicide when taking medicine for a major depressive disorder and other psychiatric disorders. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Some young people have thoughts about suicide when taking medicine for a major depressive disorder and other psychiatric disorders. Your doctor will need to check your progress at regular visits while you are using Abilify. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Stop using Abilify and call your doctor at once if you have the following symptoms: fever with stiff muscles and rapid heart rate; uncontrolled muscle movements; symptoms that come on suddenly such as numbness or weakness, severe headache, and problems with vision, speech, or balance.

Before taking this medicine

You should not take Abilify if you are allergic to aripiprazole.

Abilify is not approved for use in psychotic conditions related to dementia. Aripiprazole may increase the risk of death in older adults with dementia-related conditions.

To make sure Abilify is safe for you, tell your doctor if you have ever had:

  • liver or kidney disease;

  • heart disease, high or low blood pressure, heart rhythm problems;

  • high cholesterol or triglycerides (a type of fat in the blood);

  • low white blood cell (WBC) counts;

  • a heart attack or stroke;

  • seizures or epilepsy;

  • trouble swallowing;

  • a personal or family history of diabetes; or

  • an obsessive-compulsive disorder, impulse-control disorder, or addictive behaviors.

Some young people have thoughts about suicide when taking medicine for a major depressive disorder and other psychiatric disorders. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

The liquid form (oral solution) of this medication may contain up to 15 grams of sugar per dose. Before taking Abilify oral solution, tell your doctor if you have diabetes.

Abilify may cause you to have high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis while you are taking this medicine.

The orally disintegrating tablet form of this medication may contain over 3 milligrams of phenylalanine per tablet. Before taking Abilify Discmelt, tell your doctor if you have phenylketonuria.

Taking antipsychotic medicine in the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant, do not stop taking Abilify without your doctor’s advice.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of aripiprazole on the baby.

Aripiprazole can pass into breast milk. It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

How should I take Abilify?

Take Abilify exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Do not take Abilify for longer than 6 weeks unless your doctor has told you to.

Abilify can be taken with or without food.

Swallow the regular tablet whole and do not crush, chew, or break the tablet.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

To take the orally disintegrating tablet (Discmelt):

  • Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil. Do not push a tablet through the foil or you may damage the tablet.

  • Use dry hands to remove the tablet and place it in your mouth.

  • Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet.

Use Abilify regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

You should not stop using Abilify suddenly. Stopping suddenly may make your condition worse.

Your doctor will need to check your progress while you are using this medicine.

Store at room temperature away from moisture and heat. Abilify liquid may be used for up to 6 months after opening, but not after the expiration date on the medicine label.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include drowsiness, vomiting, aggression, confusion, tremors, fast or slow heart rate, seizure (convulsions), trouble breathing, or fainting.

What should I avoid while taking Abilify?

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Dizziness or severe drowsiness can cause falls, fractures, or other injuries.

Avoid drinking alcohol. Dangerous side effects could occur.

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking Abilify.

Abilify side effects

Get emergency medical help if you have signs of an allergic reaction to Abilify: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe agitation, distress, or restless feeling;

  • twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;

  • mask-like appearance of the face, trouble swallowing, problems with speech;

  • seizure (convulsions);

  • thoughts about suicide or hurting yourself;

  • severe nervous system reaction–very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;

  • low blood cell counts–sudden weakness or ill feeling, fever, chills, sore throat, swollen gums, painful mouth sores, red or swollen gums, skin sores, cold or flu symptoms, cough, trouble breathing; or

  • high blood sugar–increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, weight loss.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Talk with your doctor if this occurs.

Common Abilify side effects may include:

  • weight gain;

  • blurred vision;

  • nausea, vomiting, changes in appetite, constipation;

  • drooling;

  • headache, dizziness, drowsiness, feeling tired;

  • anxiety, feeling restless;

  • sleep problems (insomnia); or

  • cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Abilify?

Taking Abilify with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Many other drugs can interact with aripiprazole. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with Abilify.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Abilify only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 12.01.

Related questions

  • How does Abilify MyCite work?

Medical Disclaimer

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Patient Tips
  • Drug Images
  • Drug Interactions
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • En Español
  • 802 Reviews
  • Generic Availability
  • Drug class: atypical antipsychotics
  • FDA Alerts (5)

Consumer resources

  • Abilify (Aripiprazole Injection)
  • Abilify (Aripiprazole Oral Solution)
  • Abilify (Aripiprazole Tablets)
  • Abilify (Advanced Reading)
  • Abilify Intramuscular (Advanced Reading)

Other brands: Aristada, Aristada Initio, Abilify Discmelt

Professional resources

  • Abilify (AHFS Monograph)
  • … +1 more

Other Formulations

  • Abilify Maintena injection
  • Abilify MyCite
  • Autism
  • Bipolar Disorder
  • Depression
  • Agitated State
  • … +3 more

Dr. Knudsen is an assistant professor of pharmacy practice at Midwestern University College of Pharmacy—Glendale, Glendale, Arizona.

Every day the general public is bombarded with commercials advertising products or medications for weight loss, as well as direct-to-consumer advertisements cataloging long lists of side effects that include weight gain.

Data from 2 National Health and Nutrition Examination surveys by the Centers for Disease Control and Prevention’s National Center for Health Statistics show that, among adults aged 20 to 74 years, the prevalence of obesity increased from 15% (in the 1976-1980 survey) to 32.9% (in the 2003-2004 survey).1

Pharmacists often encounter patients attributing recent or long-term weight gain to their medication(s) or patients wanting to know if a new medication will cause weight gain. Sifting through each medication can be a daunting task—one that is equaled by determining if weight gain is caused by medication, lifestyle, or just plain edema.

When the source of the problem is edema associated with heart failure, and it is treated with diuretics, potassium replacement may be needed; as a result, patients may increase dietary consumption of potassium-rich food, which can lead to weight gain.2 Patients should be encouraged to keep a weight diary and report sudden weight increases to their physician. This can prevent them from developing a large buildup of fluid weight and further cardiac problems before seeking medical treatment. Patients also should be advised that prescription potassium replacement should suffice during diuretic treatment; consuming potassium and calorie-rich foods is unnecessary.

Medications associated with weight gain include antipsychotics, antidepressants, and anticonvulsants. For patients taking antipsychotics, for example, medication-induced weight gain has been cited as a contributor to decreased quality of life and nonadherence to their drug regimen.3

Atypical Antipsychotics

Of the 2 antipsychotic medication classes, the use of certain atypical antipsychotics has produced evidence supporting the risk of weight gain. This weight gain may have a relationship with the documented risk of developing diabetes during atypical antipsychotic treatment. The risk of weight gain mirrors the risk of developing diabetes for these agents. Atypical antipsychotics include aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). Aripiprazole and ziprasidone are associated with the least amount of weight gain and are listed as weight-neutral in some medical literature.4

Patients experiencing atypical antipsychotic-induced weight gain can use calorie reduction and dietary education programs, as well as pharmacologic treatment.4 Orlistat 60 mg (alli), orlistat 120 mg (Xenical), and sibutramine (Meridia) are available agents, but, currently, little literature exists regarding how they affect atypical antipsychotic-induced weight gain.

Another option is switching between antipsychotic agents.4 Switching between antipsychotics, however, is not as easy as switching between statins. The risks and benefits must be seriously considered, and patients must be monitored closely during and after the transition period. Patients can respond to antipsychotics differently depending on the agent, and little guidance is available for equivalent dosing between the agents. An American Diabetes Association consensus task force recommends changing agents if a patient gains more than 5% of baseline body weight after treatment initiation.5

Antidepressants

Although more medical literature exists regarding weight gain and antipsychotic medications, antidepressants also are associated with weight gain. Tricyclic antidepressants (TCAs) are known for their anticholinergic side effects; however, weight gain can be an unfortunate side effect as well. TCAs block histamine and serotonin receptors and peripheral alpha receptors. The blocking of these 3 receptors leads to increased carbohydrate cravings, decreased physical activity, and increased appetite. TCAs also cause decreased basal metabolic rates.6 The combination of these effects can lead to weight gain.

Mirtazapine (Remeron), an alpha-2 antagonist antidepressant, joins TCAs on the list of medications commonly causing weight gain. Of the several classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, citalopram, sertraline, paroxetine, fluvoxamine, and escitalopram,7 have a low association with weight gain because they do not have the receptor blockade like TCAs; therefore, if weight becomes an issue, switching a patient to an SSRI for depression treatment may be a good choice.7 When switching a patient between antidepressants, however, proper titration and patient counseling are very important.

Anticonvulsants

Anticonvulsants, such as carbamazepine, gabapentin, lamotrigine, lithium, and valproic acid, can produce weight gain. Approximately one fifth of patients gain ≥22 lb while on lithium treatment. This could be due to fluid retention or decreased metabolic rate from hypothyroidism, both common with lithium.8 Frequent and close monitoring of these parameters can help avoid weight gain.

Increased appetite and weight gain occur in approximately 50% of patients on long-term valproate therapy.9 Weight gain may be related to changes in metabolic rates and not to excessive food intake; excessive weight gain may result in obesity-induced hyperinsulinemia and insulin resistance.9 Carbamazepine causes weight gain less frequently than valproate.10

Diabetic Medications

Among the other most common pharmacotherapies associated with weight gain are diabetic medications, such as insulin and thiazolidinediones. An average 3% to 9% increase in weight can be a consequence of insulin therapy.11

Weight gain is predominantly from increased truncal fat and tends to be related to daily dose and plasma insulin levels. Less weight gain, when compared with more traditional insulin strategies, is achieved when patients are converted to insulin by using a bedtime injection of an intermediate- or long-acting insulin and using oral agents primarily for control during the day.11

Thiazolidinediones (rosiglitazone and pioglitazone) can cause weight gain through both fluid retention and fat accumulation.12 Thiazolidinediones stimulate appetite and fat-cell differentiation. A weight gain of 3.3 to 8.8 lb is not unusual and seems to be doserelated.13 In addition, these agents carry a black-box warning regarding the increased risk of new or worsening congestive heart failure.14 The prescribing information states, “observe patients carefully for signs and symptoms of heart failure including excessive, rapid weight gain, dyspnea, and/or edema.”14

Appropriate medical nutrition therapy and healthy lifestyle education are critical to minimize weight gain associated with insulin therapy.

Smoking-cessation Products

Weight gain during smoking cessation has been a deterrent to patients wishing to quit or being successful in their attempts.15 Patients hoping to find a medication that assists with smoking cessation and causes weight loss or be weight-neutral will be disappointed to learn that sustained-release bupropion (Zyban) and nicotine-replacement therapies—in particular nicotine gum—have been shown to delay, but not prevent, weight gain.16 Pharmacists must educate patients about lifestyle modifications and choices during smoking cessation to decrease the risk of weight gain.

Oral Contraceptives

Women taking oral contraceptives (OCs) have thought that these products can be the cause of weight gain. Many of the newer OCs advertise their ability to prevent weight gain. Drospirenone (Angeliq) has antimineralocorticoid or antialdosterone activities, which may result in less weight gain, when compared with OCs containing levonorgestrel.17 A 2003 review of the data did not find evidence supporting a causal association between combination OCs or combination skin patches and weight gain.18

Counseling Is Key

Pharmacists should expect questions from patients experiencing weight gain while taking a particular medication and counsel them on the possible contributing factors, including lifestyle and edema, in addition to potential side effects of the medication itself.

PMC

Dear Editor:

Weight gain induced by atypical antipsychotics is a well known side effect.1 Among this group of medications, aripiprazole (Abilify®, Bristol Myers Squibb) has been reported to be weight neutral.2 We present here two cases that contradict this view.

A 15-year-old adolescent female subject was being treated for bipolar disorder. Aripiprazole was added to oxcarbazepine (Trileptal®, Novartis) for mood stabilization. The dose of aripirazole was increased to 10mg after one week. Two months later, the patient showed an increase in weight by 11kg. Aripirazole discontinuation was followed by loss of 2kg in the next four weeks.

An 11-year-old male subject was started on aripiprazole 5mg for aggressive behavior. The patient was also diagnosed with ADHD and was on methylphenidate HCl (Concerta®, McNeil Consumer & Specialty Pharmaceuticals) 36mg. After one month of aripiprazole, the patient gained 8kg. Aripiprazole was switched to ziprasidone HCI(Geodon®, Pfizer Inc.). The patient lost 3kg in four weeks on ziprasidone; however, due to continued concern about aggressive behavior, he was switched back to aripiprazole, and he again gained 9kg in a month.

Susceptibility to weight gain while on aripirazole was obvious in both of these patients. Most of the clinical trials have suggested that aripiprazole does not cause much weight gain. But we have to remember that most of these trials were done on an adult population. It is well known that children and adolescents can be more prone to weight gain as a side effect of atypical antipsychotics.2

Perhaps there is need for additional well-designed studies in the younger population to explore this further.

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