Abilify Side Effects

Abilify has been linked to many serious side effects and complications, including compulsive gambling, unusual urges, life-threatening reactions to the antipsychotic drug itself, increased risk of death in elderly patients, problems with metabolism and difficulty swallowing. Some of these side effects may result in permanent injury even after Abilify is discontinued, and some conditions may even become worse after stopping the drug.

*Please seek the advice of a medical professional before discontinuing the use of this drug.

Many individuals exhibit certain habits that may become bothersome that they’d like to “kick.” But patients taking Abilify, an antipsychotic drug used to treat symptoms of schizophrenia, autism spectrum disorder, Tourette’s and bipolar disorder, have reported developing habits and rituals so severe that they have become compulsions.

These uncontrollable urges, including primarily gambling, sex and shopping, have resulted in disruption to patients’ daily lives, including finances, relationships and their overall wellbeing.

man upset at gambling loss
Abilify has been linked to compulsive gambling

Abilify has also been linked to several drug-emergent reactions that can lead to serious injury or death. These conditions may be difficult to diagnose and can become permanent (irreversible) or deadly, even after discontinuing the drug, if not treated early on.

Complications associated with the use of the antipsychotic drug include problems with patients’ metabolism, leading to weight gain and dangerously high blood sugar levels, abnormally low blood pressure, seizures and difficulty swallowing.

These side effects and complications are in addition to two black box warnings; one indicating life-threatening risks to elderly patients with dementia taking Abilify, and the other advising patients that drugs like Abilify can lead to thoughts of suicide, and if prematurely stopped, even suicide itself.

Abilify and Neuroleptic Malignant Syndrome (NMS)

Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotic drugs, such as Abilify, according to a review written by The Neurohospitalist and published by the National Institutes of Health (NIH).

The condition is characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. Autonomic functioning is related to the autonomic nervous system of the body that controls involuntary or unconscious functions, such as heart rate, digestion, respiratory rate, urination, sexual arousal, fight-or-flight response and pupillary response (such as dilating and narrowing of the pupil in response to changes in light).

Approximately 10 percent of patients who develop a reaction to Abilify called neuroleptic malignant syndrome (NMS) will die from the serious side effect.

The first reported case of NMS surfaced in 1956, not long after the introduction of the antipsychotic drug chlorpromazine (thorazine). More reports quickly followed, and in a 1960 study conducted by French clinicians, NMS was given its current name. Initial reports estimated the death rate of patients acquiring NMS to be over 30 percent, but more recent reports have seen that estimate drop closer to about 10 percent.

What to Watch Out For

NMS has been associated with virtually all neuroleptics, including the newer antipsychotic drugs like Abilify. While NMS is a serious disorder that can be caused by an adverse reaction to certain medications that work by blocking dopamine receptors in the brain (responsible for controlling the brain’s reward and pleasure centers as well as regulating movement and emotional responses), it can also result from the sudden withdrawal of antipsychotic drugs as well.

It is important for patients and treating physicians to be aware of the condition of NMS because early treatment is necessary to avoid adverse outcomes, including death.

Patients can develop NMS within days or even hours of exposure to the causative drug. Most patients will exhibit symptoms within two weeks, with nearly all patients affected by the condition displaying symptoms within 30 days.

Additional signs and symptoms of the disorder can be synonymous with signs of autonomic nervous system instability frequently associated with NMS, including:

  • Unstable blood pressure (frequently changing)
  • Abnormally rapid breathing
  • Abnormally fast heart rate
  • Excessive production of saliva
  • Unusual sweating
  • Flushing
  • Pale color of the skin
  • Incontinence (loss of bladder control)

Other symptoms of the condition outside of the those directly associated to the autonomic nervous system may include:

  • Difficulty swallowing
  • Shortness of breath or difficulty breathing
  • Abnormal reflexes
  • Mutism (lacking the ability to speak)
  • Motor impairments and abnormalities, such as muscle rigidity, tremor, and other abnormal and involuntary movements
  • Seizures

Elevated creatinine phosphokinase (CPK), indicative of muscle damage, may also be present in some patients with NMS due to a condition in which damaged skeletal muscle breaks down rapidly (rhabdomyolysis) or when a patient’s white blood cells in the blood are elevated (leukocytosis). While these situations may occur in some patients, they are not specific to the syndrome nor are they present in all cases.

Treatment of NMS

NMS is considered a neurologic emergency, according to the NIH, as a delay in treatment or the withholding of therapeutic measures with the use of Abilify can potentially lead to serious complications or death. Since primary treatment of NMS requires the immediate stopping of the causative drug, hospitalization of patients is typically necessary after diagnosis.

Contrarily, if NMS is the result of withdrawal from Abilify, then the medication is re-administered as quickly as possible. The next step in treatment would be supportive measures, including hydration, cooling blankets or ice packs, the use of other medications, or any other medical therapy required to correct any metabolic abnormalities that may be present.

When treated early and aggressively, NMS is typically not fatal and most patients recover completely within two to 14 days. But if diagnosis and treatment are delayed, recovery can take several weeks or months, and surviving patients may be left with complications relative to the kidneys and the heart.

Abilify and Uncontrolled Body Movements (Tardive Dyskinesia)

Tardive dyskinesia (TD) is a disorder that is characterized by involuntary movements that most often affect the lower face. Tardive means delayed and dyskinesia means abnormal movement.

TD is a serious side effect of neuroleptics or antipsychotics such as Abilify, used to treat various mental illnesses. TD often occurs after long-term use (months or years) of these medications, but in some instances, it can result after as little as six weeks of drug use. The occurrence of TD may be related to the total lifetime dose of the medication. Once it happens, the condition may not be reversible even after the medication is discontinued.

Risk factors for developing TD aside from long-term therapy with Abilify or other antipsychotic drugs, include older age, female sex and concurrent affective disorders (psychiatric diseases or mood disorders), such as depression, bipolar disorder and anxiety disorder. About 20 percent of individuals taking antipsychotic drugs for more than one year will acquire TD.

What to Watch Out For

Tardive dyskinesia (TD) usually affects the orofacial region, or the region above the neck, in front of the ears and below the orbitomeatal line (a positioning line of the skull that passes from the eye to the ear). However, it can also affect all parts of the body, causing abnormal movements, such as myoclonic jerks (a brief, involuntary twitching of a muscle or a group of muscles), tics, chorea (jerky involuntary movements affecting mostly the shoulders, hips and face), and dystonia (involuntary contractions of the muscles).

These abnormal, involuntary movements are most apparent when a patient is awake and active, and are lessened with relaxation, disappearing altogether during sleep.

Specific signs and symptoms of TD include:

  • Facial grimacing
  • Rapid eye blinking
  • Finger movement
  • Jaw swinging
  • Repetitive chewing
  • Lip smacking, pursing or puckering
  • Tongue thrusting or protrusion
  • Rapid movement of the arms or legs
  • Other involuntary movements of the head, face, neck and tongue muscles

Treatment of Tardive Dyskinesia (TD)

Treatment of tardive dyskinesia (TD) usually begins by discontinuing the causative drug, but evidence is insufficient to show that this, or any other treatment, is successful in reducing symptoms of TD after its onset, according to American Family Physician.

Patients’ symptoms resulting from a reaction to Abilify may continue or worsen even after they stop taking the antipsychotic drug.

If the condition is mild, medicines may be used to alleviate symptoms. If TD is severe, a procedure called deep brain stimulation (DBS) may be attempted. This procedure uses a device called a neurostimulator to deliver electrical signals to regions of the brain that control movement.

Even when the antipsychotic drug like Abilify is stopped, involuntary movements characteristic of TD may become permanent and in some cases, even worsen.

Abilify and Gambling & Sexual Urges

Some patients taking Abilify have had unusual urges, such as gambling, binge eating or eating that cannot be controlled (compulsive), compulsive shopping, and sexual urges, according to drug labeling for the antipsychotic medication.

Abilify is supposed to stabilize the level of dopamine in the brain. Researchers have found, however, that in some patients, aripiprazole may overstimulate dopamine D3 receptors in the brain, which are associated with reward, motivation and impulse control.

Compulsive Gambling

A study in 2011 was the first to point to pathological gambling as a side effect of Abilify. The authors looked at three cases of pathological gambling induced by aripiprazole (the active ingredient in Abilify) in patients with schizophrenia or schizoaffective disorder. None of the patients had a history of pathological gambling. They started gambling after they began taking aripiprazole, and when they stopped taking it, the pathological behavior disappeared quickly.

A French study in 2013 looked at eight patients who were taking aripiprazole and who engaged in pathological gambling. The authors found that in seven of the eight cases, aripiprazole was a possible cause of the pathological gambling. The problem appeared between a few days and a few months after the patients started taking the drug or after a dosage increase, and decreased within a similar time after the treatment was stopped or the dosage was decreased.

A study published in JAMA Internal Medicine in 2014 analyzed records of serious adverse drug events having to do with impulse-control events for patients using six dopamine-receptor agonist medications, including Abilify. It found “evidence that dopamine receptor agonist drugs are associated with serious impulse control disorders; the associations were significant [and] the magnitude of the effects was large.”

In 2015, a study in the Journal of Clinical Psychopharmacology confirmed those findings, though for a small number of case reports. It reviewed earlier case reports and looked at 17 cases of French aripiprazole users who experienced gambling disorder. These patients “were young, impulsive and high novelty seekers and had a history of substance misuse,” so the researchers could not attribute the gambling disorder solely to their medication.

In light of all these studies, in 2016, the FDA published a Safety Announcement warning the public about reports of “compulsive or uncontrollable urges to gamble, binge eat, shop and have sex” associated with Abilify. Meanwhile, the media began to publish reports with headlines like “Patients Say Abilify Turned Them Into Compulsive Gamblers and Sex Addicts.” However, it’s worth noting that the FDA says it has uncovered only 167 cases of aripiprazole use and impulse-control problems since the drug was approved in 2002.

 

Compulsive Eating and Hypersexuality

A number of studies also link aripiprazole to compulsive eating and uncontrollable sexual urges.
A 2010 case study published in the Australian & New Zealand Journal of Psychology describes the story of a woman with schizophrenia who took Abilify, gained nearly 20 pounds in six months through compulsive eating and gambled away thousands of dollars. She had no prior history of such behavior. After her doctors took her off the medicine, the urge to gamble stopped in a month, and she lost weight.

As for uncontrollable sexual urges, one study talked about a woman with schizoaffective disorder who began taking 30 mg of aripiprazole daily and reported “elevated libido and an unstoppable sexual desire.” Another described the case of a 36-year-old schizophrenia patient who had never engaged in sexual relationships. After taking 20 mg of aripiprazole a day “she exhibited increased sexual urges and activities.” When she was taken off the drug, at her insistence, her libido level subsided.

What to Watch Out For

Uncontrollable or obsessive urges, including compulsions, can be classified as a condition called obsessive-compulsive disorder (OCD). OCD is a chronic, long-term disorder in which the affected person has uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over, as defined by the National Institutes of Health (NIH).

People with OCD who experience these obsessions, compulsion or both, may struggle in all aspects of life, including work, school and relationships.

Obsessions that result in repetitive thoughts, urges or mental images can also cause anxiety. Common signs and symptoms of obsessions include:

  • Fear of germs or contamination
  • Unwanted, forbidden or “taboo” thoughts of sex, religion or harm
  • Aggressive thoughts towards one’s self or others
  • Needing to have things in a perfect order, or symmetrical

Common compulsions experienced by individuals with OCD include:

  • Acute bacterial sinusitis (inflammation of the sinuses)
  • Excessive cleaning and/or handwashing
  • Ordering or arranging things in a certain, precise way
  • Repeatedly checking on things
  • Compulsive counting

These habits and rituals, in order to be classified as obsessive or compulsive, must be unable to be controlled, must take up a significant portion of a person’s day (at least one hour), must not result in pleasure and must cause problems in a person’s daily life.

Treatment of OCD

Obsessive-compulsive disorder (OCD) is typically treated with a combination of medication and psychotherapy. However, some patients will continue to experience symptoms even after treatment.

Fact

Obsessive and compulsive symptoms can continue for life in some patients.

OCD can sometimes lead to or be associated with other mental disorders, such as anxiety, depression and body dysmorphic disorder (when an individual believes some part of their body is abnormal when it’s not). These accompanying conditions may need to be treated along with OCD.

Research shows that certain types of psychotherapy, such as cognitive behavior therapy (CBT), can be just as effective as medication (including SRIs and SSRIs) for some patients, according to the NIH. The NIH is also researching new treatments for people with OCD who do not respond well to other generally accepted treatment options. These new treatments include deep brain stimulation (DBS), a technique designed to activate or inhibit the brain directly with electricity, or electrodes placed on the scalp.

Other Serious Side Effects

Drug labeling for Abilify also warns of an increased risk of death in elderly patients with dementia-related psychosis taking the antipsychotic drug, noting that the medication has not been FDA-approved to treat dementia patients. Elderly patients are likewise at an increased risk for stroke resulting from the use of antipsychotic drug.

Although Abilify is not necessarily classified as an antidepressant, it includes the warning for risk of suicidal thoughts or actions required of all medicines used in the treatment of depression and other serious mental illness. The label advises patients not to stop taking Abilify without first talking to their doctor.

woman with stomach pains

Signs and symptoms of high blood sugar may include:

  • Feeling very thirsty
  • Frequent urination
  • Feeling very hungry
  • Feeling weak or tired
  • Feeling sick or upset stomach
  • Feeling confused
  • Fruity-smelling breath

Abilify has also been found to result in problems with patients’ metabolism, or set of life-sustaining chemical processes within the body’s cells. These can include increases in blood sugar, which at very high levels can lead to coma or death.

Patients with diabetes (a disease in which blood sugar levels are already too high) or those at risk for diabetes (such as individuals who are overweight or have a family history of diabetes), should have their blood sugar levels checked prior to taking Abilify.

Other problems with a patient’s metabolism might include unexplainable or rapid weight gain along with increased fat levels (including cholesterol and triglycerides) in the blood.

Patients taking Abilify might also experience the following serious side effects and complications:

  • Orthostatic hypotension (decreased or abnormally low blood pressure) – patients might experience lightheadedness or fainting especially when standing up too quickly or getting up from a sitting or lying down position.
  • Low white blood cell count – this condition places patients at an increased risk for infection.
  • Problems with control of body temperature – especially during frequent exercise or in areas with extreme heat; increasing water intake is important to prevent dehydration.
  • Difficulty swallowing – this can cause food or liquid to get into a patient’s lungs, which can sometimes result in pneumonia.
  • Seizures (convulsions)

Author

Kristin Compton is a medical writer with a background in legal studies. She has experience working in law firms as a paralegal and legal writer. She also has worked in journalism and marketing. She’s published numerous articles in a northwest Florida-based newspaper and lifestyle/entertainment magazine, as well as worked as a ghost writer on blog posts published online by a Central Florida law firm in the health law niche. As a patient herself, and an advocate, Kristin is passionate about “being a voice” for others.


Hide Sources

  1. Berman, MD, MS, B. D. (2011). Neuroleptic Malignant Syndrome: A Review for Neurohospitalists. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726098/
  2. DailyMed, NIH. (3 June 2010). Label: Abilify – aripiprazole tablet. Retrieved from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=B40BFD2B-9FF1-45BF-A40F-E9812F1DF228#Section_6.3
  3. FDA. (2016). Medication Guide: Abilify. Retrieved from: https://www.fda.gov/downloads/Drugs/DrugSafety/ucm085804.pdf
  4. MedlinePlus, NIH. (30 May 2016). Tardive dyskinesia. Retrieved from: https://medlineplus.gov/ency/article/000685.htm
  5. Monson, PharmD, K. and Schoenstadt, MD, A. (6 January 2017). Abilify Warnings and Precautions. Retrieved from: http://bipolar-disorder.emedtv.com/abilify/abilify-warnings-and-precautions.html
  6. Muench, MD, MPH, J. and Hamer, PharmD, BCPP, A. M. (1 March 2010). Adverse Effects of Antipsychotic Medications. Retrieved from: http://www.aafp.org/afp/2010/0301/p617.html
  7. NIH. (2016). Obsessive-Compulsive Disorder. Retrieved from: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
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