Aripiprazole

Aripiprazole is licensed for:

• Mania in Bipolar Disorder
• Schizophrenia
• Agitation or disturbed behaviour in schizophrenia

It is sometimes also used for things like:

• ADHD
• Anxiety
• Bipolar depression
• Psychosis

Aripiprazole can help to adjust the levels of the dopamine in your brain

The brain is usually good at making sure we have enough of the chemicals we need to function properly.

• Experiments suggest that mania and psychosis are more likely to happen when the brain has too much of a chemical called dopamine.
• Amphetamines, which are stimulants and release dopamine, can bring on psychosis in people who do not have the condition. So scientists think that this is the way that the chemicals act in psychosis.
• Aripiprazole reduces dopamine activity where it is too high, therefore helping with symptoms like hallucinations. It also increases dopamine activity in areas of the brain where it is low, so helping with symptoms like poor motivation.
• Aripiprazole works through attaching itself to the same receptors in the brain that are activated by dopamine.

You should take aripiprazole as agreed with your doctor

• You will get the best effect from aripiprazole if you take it regularly.
• Make sure that you know your dose. If it is not written on the label, check it with your pharmacist or doctor.
• You may start with a low dose taking the liquid, and then move on to tablets when your dose increases.
• You will usually take your dose once a day.
• It doesn’t matter what time you take it each day – choose a time that you can always remember. This could be a mealtime, or when you brush your teeth.
• You can take the tablets or liquid before or after food.

• For the normal coated tablets, swallow them whole with a drink of water - if you chew it, it tastes bitter.
• For the orodispersible (‘melt in your mouth’) tablets, put it on your tongue and let it dissolve there. You can also dissolve them in some water and then drink it all down.

• You cannot mix the oral solution with any drink or food. Just take it on its own.

• A doctor or nurse can use the injection to give you a fast-acting dose of aripiprazole if you are very agitated. You can have a tablet at the same time – under the supervision of a doctor – which will make the effect last longer.
• A doctor or nurse can give you the long acting injection of aripiprazole every month if it is the most suitable for you.

• When you start the long-acting injection, you may also have some tablets until the medicine level is high enough in your body.

If you forget to take a dose then just take it as soon as possible unless it is getting close to your next dose

• It can take a few days, or sometimes even weeks, for aripiprazole to start helping you.

What to do if you miss a dose of the tablets or liquid:

• If you remember later during the day, take it as soon as possible.
• If you forget to take it by bedtime, just start again on the next day.
• Do not take a double dose.

What might happen?

• If you forget to take your medicine for a few days, you may start getting your old symptoms back. This means that you should talk to your doctor about it

In the first 2 or 3 weeks some of the side effects (such as feeling agitated and restless or feeling sick) may make you feel worse. They should wear off quite quickly but if they are a problem to you speak to your doctor or care team.

You must go to A&E if you take too much 

What to do if you take too much:

• If you have taken more aripiprazole than it said on the label, you must get help quickly – even if you do not feel any different.
• Go to A&E. Take your medicine with you, to show to the doctors. Tell them how much you have taken.
• Get a friend or family member to go with you, if you can, just in case you feel ill on the way.

You might get any of the following signs:

• Tiredness and sleepiness
• Fast heart beat (tachycardia)
• Feeling – or being – sick
• Loose poo (diarrhoea)
• Fainting or losing consciousness
• Strange movements of your muscles that you cannot control 
• Drooling

It can take a few days, or sometimes a few weeks, for aripiprazole to start helping you

• It is hard to know – for each individual person – how long it will take for aripiprazole to start working for you
• It could be as short as a few days, or more like a few weeks
• If you have had no change by the end of 2-3 weeks, you could talk to your doctor about other medicines. However it can take 4-6 weeks for aripiprazole to take full effect.

Tell your doctor or pharmacist before you take aripiprazole if you have any of these conditions

You need to talk to your doctor or pharmacist if any of the following apply to you:

• You have high blood sugar (with symptoms such as a great thirst, going to wee a lot, an increase in your appetite, and/or feeling weak) or a family history of diabetes
• You have ever had fits (seizures)
• You have had strange muscle movements that you cannot control, especially in the face
• You have heart problems, or a family history of heart problems, stroke or "mini" stroke, or high/low blood pressure
• You have ever had blood clots, or you have a family history of blood clots
• You have ever had an experience of gambling that you could not control

If you have any thoughts of suicide, or of other ways of hurting yourself, go straight to a hospital with your tablets.

This may be a side-effect, and you need urgent help.

Aripiprazole can make some people think about hurting themselves or committing suicide. This can happen to anyone, including people who are under 18.

You must go straight to hospital with your tablets if you have any of these thoughts. You must tell the doctor that you are taking aripiprazole. There are other things you can take instead.

If you start to get abnormal movements that you cannot control, you should go and see your doctor as soon as possible

• Antipsychotic medicines can cause a wide variety of problems with movement such as tremors, restlessness and agitation and unusual movement with your lips, tongue, hands or pelvis.
• If the movements are severe then you might find it difficult to speak, eat or breathe.
• These are called extra-pyramdal side effects.
• Aripiprazole is less likely to cause these movements than some of the older antipsychotics.
• A subgroup of the movement side effects is called tardive dyskinesia.
• This is an uncommon side effect of aripiprazole. It can occur in up to 1 in 100 people.
• The first sign might be some movements of your tongue that you cannot control, and they may be quite regular and rhythmic.
• The problem with tardive dyskinesia is that it might not stop, even if you stop taking your medicine.
• If you notice it early and take action with your doctor, the problem should not get worse.
• Go to see your doctor straight away.

Aripiprazole has different side-effects than many other antipsychotics, but if they happen they can be serious

Some side effects of aripiprazole may be less common than with other antipsychotics.

Some side-effects of aripiprazole may – strangely - seem like other mental health symptoms. Some side-effects here are also the opposites of each other. The balance of chemicals in the brain is very fragile, and hard to control! If they do not get better after a few days on the tablets, go back to the doctor.

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

Young people were more likely than adults to get some side-effects in tests

Young people and aged 13 and over were more likely than adults to get the following side-effects:

• Extreme tiredness and sleepiness
• Dry mouth
• Strange movements and twitches of muscles that they could not control
• Dizziness
• Increased appetite and weight gain
• Restlessness
• Pain in the gut (abdomen)
• Fast heartbeat

The doctor may need to change your aripiprazole dose when you are taking some other types of medicines

Tell your doctor or pharmacist before you take aripiprazole if you are already taking these medicines, as they may need to change your dose of aripiprazole:

• Medicines to correct heart rhythm
• Medicines to treat high blood pressure
• Antidepressants or herbal remedies used to treat low mood (depression) and anxiety
• Antifungal agents
• Medicines to treat HIV infection
• Anticonvulsants used to treat epilepsy

If you have any further questions about this, you should speak to your doctor or pharmacist.

Always tell the doctor if you are taking other medicines.

Tell the pharmacist you are taking aripiprazole if you buy medicines (including things you put on your skin) for common illnesses.

Get your weight, height waist circumference and blood checked regularly when you start aripiprazole

• Young people who take antipsychotic medicines should have some regular checks while taking these medicines
• When you begin the treatment, the doctor should take a note of your weight and height and blood pressure
• They should also do blood tests to check your liver, blood sugar, and some hormones
• They may even do a heart machine test called an ECG (electrocardiogram) if you are at risk of heart disease

These tests should be done again regularly, especially during the first few weeks of your treatment.

Aripiprazole can make people feel like gambling out of control

• Aripiprazole has showed a side-effect where people feel like gambling to extremes
• If you have ever had problems with gambling, you should talk to your doctor about this before you take it
• You could ask your family or friends to help you to make sure that this does not start happening to you

Be careful if you are also using drugs 

• Antipsychotics block the effect of dopamine, so this means the ‘high’ may not be as ‘high’ as before from any drug.
• You may be tempted to increase your dose of the drug to make up for it, but this could be dangerous.
• Cannabis can make drowsiness worse with aripiprazole.
• Methadone can make drowsiness worse with aripiprazole.
• Aripiprazole could reduce your craving for cocaine, and could reduce the level of happiness that you feel when taking cocaine.
• Aripiprazole and stimulant drugs such as Amphetamines can affect the heart and this can be dangerous when taken together.

Stopping the medication causes the balance of chemicals in the brain to alter

• Once you start taking an antipsychotic, the brain adjusts to having a new level of dopamine around.
• If you stop taking the antipsychotic all at once, the balance starts to change again. You could get your old symptoms back.
• People usually take aripiprazole for some weeks, to keep those symptoms away.

Stopping this medicine quickly, or reducing the dose too much at once, may cause your old symptoms to come back

You can stop taking it safely with your doctor’s help

• You will probably get your old symptoms back if you stop aripiprazole suddenly.
• It is better to agree stopping with a doctor who will reduce you gradually.
• The speed at which you reduce depends on how unwell you were and how long you have been on aripiprazole.
• The best way to stop aripiprazole is to slowly reduce the dose over at least 3 weeks and then stop.
• If aripiprazole is stopped suddenly, it can cause some unpleasant discontinuation or withdrawal symptoms like headache, feeling sick and sleep problems.