Adderall and abilify
Other Medications, Alcohol, and More
Adderall (amphetamine/dextroamphetamine) is a prescription drug that’s used to treat attention deficit hyperactivity disorder (ADHD) in adults and some children. Adderall is also used to treat narcolepsy. Like other drugs, Adderall may have interactions.
Some interactions occur because one substance causes another substance to have a different effect than expected. For example, sometimes alcohol, another drug, or a supplement can affect how a drug acts in your body. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Adderall’s possible interactions. And for more information about Adderall, including details about its uses, see this article.
Adderall vs. Adderall XR
There are two forms of Adderall available: Adderall and Adderall XR. Adderall is the immediate-release form of the drug. This means that after you take a dose, the drug begins working right away. But the drug’s effects don’t last all day.
Some people may only need to take Adderall once per day, while others may take it every 4 to 6 hours.
On the other hand, Adderall XR is an extended-release form of the drug. That means the drug is slowly released into your body over time to manage your ADHD symptoms. Adderall XR is only taken once daily.
Adderall and Adderall XR contain the same active ingredients, amphetamine and dextroamphetamine. This means they also have the same interactions. But this article focuses on Adderall only.
To learn more about Adderall XR, talk with your doctor.
Certain health conditions or other factors could raise your risk of harm if you take Adderall. In that case, your doctor may not prescribe Adderall for you. This is known as a contraindication. The list below includes contraindications of Adderall.
If you have a history of drug misuse. Adderall has a risk of misuse and dependence. In fact, the drug has a boxed warning for this risk. (To learn more, see the “Boxed warning” section at the beginning of this article.
) If you’ve misused or been dependent on drugs before, your doctor may recommend a drug other than Adderall.
If you have heart disease or high blood pressure. Adderall may raise your risk of heart problems or high blood pressure. If you already have heart disease or high blood pressure, taking Adderall could worsen your condition. If you have one of these conditions, talk with your doctor before taking Adderall. Your doctor will likely recommend a different drug for you.
If you have hyperthyroidism. If you have hyperthyroidism (overactive thyroid), your doctor will likely treat this condition before prescribing Adderall. This is because Adderall can make the symptoms of an overactive thyroid even worse.
If you have glaucoma. Adderall can cause increased eye pressure. If you have glaucoma, taking Adderall may make your condition worse. Your doctor will likely recommend a drug other than Adderall for your condition.
If you have agitation.
If you have agitation, your doctor may recommend a drug other than Adderall for you. This is because Adderall may make your agitation worse.
If you’ve recently taken a monoamine oxidase inhibitor (MAOI). Your doctor will not prescribe Adderall if you’re currently taking an MAOI or have taken one in the past 14 days. This is because taking an MAOI with Adderall may raise your risk of serious high blood pressure, which can even be life threatening. To help prevent this interaction, you should wait at least 14 days after your last dose of an MAOI before taking Adderall. Examples of MAOIs may include:
- phenelzine (Nardil)
- methylene blue (ProvayBlue)
- selegiline (Emsam)
- tranylcypromine (Parnate)
- isocarboxazid (Marplan)
If you’ve had an allergic reaction. If you have had an allergic reaction to Adderall or any of its ingredients, your doctor likely won’t prescribe Adderall. You can ask them about other treatments that may be better options for you.
Before you start taking Adderall, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Adderall is safe for you to take.
Adderall may interact with alcohol. It’s best to avoid alcohol while you’re taking Adderall. This is because alcohol can raise your risk of certain side effects from Adderall. For example, both Adderall and alcohol can both cause high blood pressure or fast or irregular heartbeat. Combining alcohol and Adderall can raise your risk of these side effects. Or it could make these side effects more severe if you do experience them.
In addition, alcohol may worsen symptoms of attention deficit hyperactive disorder (ADHD), which Adderall is used to treat.
Drinking alcohol while taking Adderall may decrease the effects that you feel from alcohol. This may cause you to drink more than usual, which can be dangerous.
If you drink alcohol, talk with your doctor before taking Adderall.
Before you start taking Adderall, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take.
Sharing this information with them may help prevent possible interactions.
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The chart below lists drugs that may interact with Adderall. Keep in mind that this chart does not include all drugs that may interact with Adderall. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
| Alkalinizing agents | • acetazolamide • sodium bicarbonate | • Can increase the effects of Adderall • Can raise the risk of side effects from Adderall |
| Tricyclic antidepressants (TCAs) | • doxepin (Silenor) • desipramine • (Norpramin) • amitriptyline • nortriptyline (Pamelor) | • Can increase the risk of serotonin syndrome • Can increase the effects of Adderall or TCAs |
| Selective serotonin reuptake inhibitors (SSRIs) | • fluoxetine (Prozac) • sertraline (Zoloft) • citalopram (Celexa) • paroxetine (Paxil) | Can raise the risk of side effects from Adderall and SSRIs |
| Serotonin Norepinephrine reuptake inhibitors (SNRIs) | • duloxetine (Cymbalta) • venlafaxine (Effexor XR) • desvenlafaxine (Pristiq) | Can increase the risk of side effects from Adderall and SNRIs |
| Quinidine | Can increase the risk of side effects from Adderall and Quinidine | |
| Ritonavir (Norvir) | Can raise the risk of side effects from Adderall and Ritonavir | |
| Triptans | • sumatriptan (Imitrex) • zolmitriptan (Zomig) • eletriptan (Relpax) • rizatriptan (Maxalt) | Can increase the risk of side effects from Adderall and triptans |
| Certain opioids | • tramadol (Ultram) • fentanyl (Subsys) • meperidine (Demerol) | Can raise the risk of side effects from Adderall and certain opioids. Adderall can also increase the effects of Meperidine. |
| Lithium (Lithobid) | Can increase the risk of side effects from Adderall and lithium Can make Adderall less effective | |
| Buspirone | Can raise the risk of side effects from Adderall and buspirone | |
| Monoamine oxidase inhibitors (MAOIs) | • tranylcypromine (Parnate) • isocarboxazid (Marplan) • methylene blue (ProvayBlue) • selegiline (Emsam) | Can raise the risk of serious side effects from Adderall and MAOIs. Due to this risk, your doctor will not prescribe an MAOI with Adderall. For more information, see “When should I avoid Adderall?” above. |
| Chlorpromazine | Can make Adderall less effective | |
| Ethosuximide (Zarontin) | Can make ethosuximide less effective | |
| Haloperidol (Haldol) | Can make Adderall less effective | |
| Certain seizure medications | • phenobarbital • phenytoin (Dilantin) • topiramate (Topamax) | Can make your seizure medication less effective |
| Proton pump inhibitors | • omeprazole (Prilosec) • esomeprazole (Nexium) • pantoprazole (Protonix) | Can make Adderall less effective |
| Antacids | • sodium bicarbonate (Alka-Seltzer) • magnesium hydroxide • calcium carbonate (Tums) | Can increase your risk of side effects from Adderall |
| h3 Blockers | • cimetidine (Tagamet HB) • ranitidine (Zantac) • famotidine (Pepcid AC) | Can raise your risk of side effects from Adderall |
| Bupropion (Wellbutrin SR) | Can increase your risk of side effects from bupropion | |
| Phentermine (Adipex-P) | Can raise your risk of side effects from Adderall and phentermine | |
| Trazodone | Can increase your risk of side effects from Adderall and trazodone | |
| Atomoxetine (Straterra) | Can raise your risk of side effects from Adderall and atomoxetine | |
| blood pressure drugs | • propranolol (Inderal LA, InnoPran XL) • metoprolol succinate (Toprol XL) • losartan (Cozaar) • lisinopril (Zestril) | Can make your blood pressure medication less effective |
Learn more about certain drug interactions that can occur with Adderall.
Interaction with serotonin norepinephrine reuptake inhibitors (SNRIs)
Adderall may interact with certain antidepressants, such as SNRIs. See the chart below for details.
| What could happen | Examples of SNRIs | What you can do |
| Can cause serotonin syndrome, a drug reaction that can be dangerous | • duloxetine (Cymbalta) • venlafaxine (Effexor XR) • desvenlafaxine (Pristiq) | Before taking Adderall, your doctor will discuss the risk of serotonin syndrome with you. During your Adderall treatment, watch for symptoms of serotonin syndrome, including agitation, confusion, or twitching muscles. If you develop symptoms, call your doctor right away or go to the hospital. |
Interaction with Bupropion (Wellbutrin SR)
Adderall may interact with bupropion, which is an antidepressant. Learn more in the chart below.
| What could happen | What you can do |
| Can raise your risk of having a seizure, especially if you’ve had seizures in the past | Your doctor may monitor your seizure risk closely while you take Adderall with Wellbutrin. In some cases, they may recommend that you take a drug other than Adderall to treat your condition |
Interaction with atomoxetine (Stratera)
Adderall and atomoxetine may interact, as described below.
| What could happen | What you can do |
| Can raise the risk of high blood pressure | Due to this risk, your doctor will likely monitor your blood pressure closely while you’re taking both Adderall and Strattera. Or if they determine it’s not safe for you to take Adderall and Strattera together, they’ll recommend other treatment options. |
Adderall may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details.
Does Adderall interact with supplements?
Before you start taking Adderall, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take.
Sharing this information with them may help you avoid possible interactions.
Adderall may interact with a supplement containing tryptophan. This is because tryptophan increases the amount of serotonin in your body. And taking this with Adderall may increase your risk of serotonin syndrome occurring.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Adderall interactions with herbs
Adderall can interact with an herbal supplement called St. John’s wort, which may be used to treat depression.
Taking Adderall with St. John’s wort can raise your risk of serotonin syndrome, a drug reaction that can be dangerous. Due to this risk, your doctor may recommend that you stop using St. John’s wort during your Adderall treatment.
If you have questions about this interaction, talk with your doctor or pharmacist.
Adderall interactions with vitamins
Adderall may interact with vitamin C. Taking Adderall with vitamin C could make Adderall less effective.
Due to this risk, your doctor may recommend spacing out your doses of Adderall and vitamin C by at least 1 hour to prevent this interaction.
Does Adderall interact with food?
Adderall can interact with caffeine. This is because both Adderall and caffeine have stimulant effects. When used together, this can raise your risk of certain side effects from the medication, including anxiety or a fast heartrate. Due to this risk, your doctor may recommend limiting your caffeine during your Adderall treatment.
Examples of foods and drinks that may contain caffeine include:
- coffee
- chocolate
- soda
- some dietary supplements
- teas, including green tea
Does Adderall interact with lab tests?
Adderall may interfere with a urine test used to check your corticosteroid levels. Your doctor may order this test if they’re trying to see how well your adrenal glands are working.
If you need to have a urinary steroid test done, it’s important that your doctor knows you’re taking Adderall.
Does Adderall interact with cannabis or CBD?Cannabis (marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Adderall.
Before you start treatment with Adderall, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Adderall. Before taking Adderall, talk with your doctor about your health history. They’ll determine whether Adderall is right for you.
Health conditions or other factors that might interact with Adderall include:
- Tourette syndrome or tics. Tell your doctor if you have Tourette syndrome or tics. Adderall may worsen the symptoms of these conditions.
During your Adderall treatment, your doctor may monitor you closely to make sure the drug isn’t making the symptoms of your condition worse. - Blood circulation problems. Adderall may decrease your blood circulation, especially to your fingers or toes. If you already have a condition that affects blood circulation, such as Raynaud’s phenomenon, Adderall may make your condition worse. Your doctor can determine if Adderall is a safe treatment option for you.
- Heart problems, including high blood pressure. Adderall can raise your risk of heart problems, including heart attack or stroke. If you already have heart problems, taking Adderall could make them worse. Before taking Adderall, tell your doctor about any heart problems you have. They may monitor your heart during your treatment. In some cases, they may recommend a drug other than Adderall for you.
- Glaucoma. Adderall can cause increased eye pressure. If you have glaucoma, taking Adderall may make your condition worse.
Your doctor will likely recommend a drug other than Adderall for your condition. - Mood disorders. If you have certain mood disorders, such as anxiety or bipolar disorder, Adderall could worsen your condition. Due to this risk, your doctor may recommend a drug other than Adderall for you.
- Seizures. If you have a seizure disorder, taking Adderall could raise your risk of a seizure. If you’ve had seizures before, your doctor can determine whether it’s safe for you to take Adderall. And if you have a seizure while taking Adderall, your doctor will have you stop taking the drug and switch to a different treatment.
- Thyroid problems. Adderall may make symptoms of hyperthyroidism (overactive thyroid) worse. For example, both Adderall and hyperthyroidism can cause a fast heart rate. Your doctor will likely treat your thyroid condition before prescribing Adderall.
- Pregnancy. It’s not known if it may be safe to take Adderall during pregnancy.
If you’re pregnant or planning to become pregnant, talk with your doctor before taking Adderall. - Breastfeeding. You should not breastfeed while taking Adderall. Adderall passes into breast milk and can cause side effects in a breastfed child. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
- Past drug dependence or misuse. Adderall has a risk of misuse and dependence. In fact, the drug has a boxed warning for this risk. (To learn more, see the “Boxed warning” section above.) If you’ve misused or been dependent on drugs before, your doctor may recommend a drug other than Adderall.
- Allergic reaction. If you’ve had an allergic reaction to Adderall or any of its ingredients, your doctor will likely not prescribe Adderall. You can ask them about other treatments that may be better choices for you.
Find answers to some frequently asked questions about Adderall and possible interactions.
Does Adderall interact with benzodiazepines?
Adderall isn’t known to interact with benzodiazepines. Benzodiazepines are a group of drugs that can be used to treat anxiety. Examples of benzodiazepines include:
- clonazepam (Klonopin)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
It’s important to note that clonazepam can also be used to treat certain seizure disorders. Adderall may raise your risk of seizures. If you’re using clonazepam for a seizure disorder, talk with your doctor before taking Adderall. They can determine if it’s safe for you to take these drugs together.
Is it safe to take Adderall with gabapentin (Neurontin)?
It should be safe to take gabapentin with Adderall. There aren’t any known interactions between these drugs.
Gabapentin is a drug used to treat nerve pain or to manage seizure disorders. Adderall may raise your risk of seizures. If you take gabapentin for a seizure disorder, talk with your doctor before taking Adderall.
They can determine if these drugs are safe to take together.
Can I take Adderall with Abilify?
Yes, you can likely take Adderall with aripiprazole (Abilify). These drugs are not known to interact with each other.
Abilify is a drug that treats certain mood disorders, such as bipolar disorder or major depressive disorder. If you have other questions about taking these drugs together, talk with your doctor or pharmacist.
Can I take Adderall with the supplement lion’s mane?
There aren’t any reported interactions between Adderall and the mushroom supplement lion’s mane. Lion’s mane may be used to treat anxiety, depression, or nerve problems.
If you’re interested in taking lion’s mane during your Adderall treatment, talk with your doctor or pharmacist.
Taking certain steps can help you avoid interactions with Adderall. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
- What to do if you start taking a new drug during your Adderall treatment.
It’s also important to read Adderall’s label and other paperwork that comes with the drug. You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the prescribing information) may have other details about interactions. If you need help understanding this information, your doctor or pharmacist can help.
Taking Adderall exactly as prescribed can also help prevent interactions.
If you still have questions about Adderall and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Does my risk of interactions depend on my Adderall dosage?
- Do other drugs for ADHD or narcolepsy have the same interactions as Adderall?
- Should I tell you if I start taking another medication or supplement while I’m taking Adderall?
- Could I still take Adderall even if it interacts with a health condition I have?
If you take Adderall for ADHD, you can learn more about your condition by signing up for Healthline’s ADHD newsletter.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Uses, Interactions, Dosage & Aripiprazole Warnings
Abilify (aripiprazole) is an antipsychotic medicine used to treat schizophrenia, bipolar disorder, Tourette syndrome and irritability associated with autism.
It may be used in combination with an antidepressant to treat depression.
Abilify is part of the second generation of antipsychotic medicines, which also includes Risperdal (risperidone) and Symbyax (olanzapine and fluoxetine). These medications are known as atypical antipsychotics.
Most other drugs in this class block chemical receptors for dopamine or serotonin in the brain. These two neurotransmitters are responsible for a large portion of psychiatric symptoms and behavior.
But aripiprazole works differently. It either enhances or inhibits both dopamine and serotonin levels to keep a balance. Doctors call it a dopamine-serotonin system stabilizer. That effect makes it a useful tool to prescribe alongside other medications to enhance their effectiveness.
Did You Know?
Abilify is part of a group of drugs called atypical antipsychotics, or second generation antipsychotics.
Source: Food and Drug Administration
Otsuka Pharmaceutical Co.
makes the brand name medication in tablets. The company also makes Abilify Maintena, an extended-release injection for patients with schizophrenia or bipolar disorder.
Bristol-Myers Squibb Company makes Abilify in an orally disintegrating tablet, oral solution and injection.
The Food and Drug Administration approved aripiprazole in 2002. Otsuka’s patent expired in 2014, and the FDA approved the first generic versions in 2015.
About the same time, studies identified the drug as a possible source of impulse-control problems. These potential Abilify side effects include compulsive gambling, overeating and uncontrollable sexual urges.
FDA-Approved Uses
The FDA first approved Abilify in 2002 for the treatment of schizophrenia in patients older than 13. The agency has since approved it to treat symptoms of other mental health, developmental and nervous system disorders in adults, adolescents and children as young as 6 years old.
The tablets and oral solution have five approved uses.
The injections are indicated only for agitation associated with schizophrenia or bipolar mania. One 2022 study recommended considering aripiprazole as the first treatment option in the early stages of schizophrenia for patients with affective symptoms.
FDA Approval Timeline: Abilify Oral Formulations
- 2002
The FDA approves aripiprazole for treatment of schizophrenia after clinical studies of more than 1,000 patients showed significant improvements in the positive and negative symptoms of schizophrenia.
- 2005
The FDA expands use to include treatment of bipolar disorder after clinical trials demonstrated significant improvement in the symptoms of acute manic or mixed episodes.
- 2007
The FDA approves the use of Abilify along with antidepressants for treatment of major depressive disorder after studies demonstrated significant improvement in symptoms among adult patients with a primary diagnosis of the condition.
- 2009
Aripiprazole wins approval as a treatment for irritability associated with autistic disorder based on study results.
- 2014
The FDA approves the drug for treatment of Tourette’s disorder after two trials established its effectiveness in children with the disorder.
Doctors also prescribe the medication for off-label uses, which are uses that lack FDA approval. These included insomnia, delusional disorders and anxiety spectrum disorders. Medical researchers are conducting clinical trials to see if aripiprazole deserves approval as a treatment for a broader range of maladies.
Meanwhile, Bristol-Myers Squibb agreed in 2016 to pay $19.5 million to settle allegations that it marketed Abilify to seniors with dementia and Alzheimer’s disease even though the drug wasn’t approved for those uses.
Use with Antidepressants
One of Abilify’s approved uses is to treat major depressive disorder in combination with antidepressants. When the FDA approved this use in 2007, it helped propel the drug to its blockbuster status.
Antipsychotic drugs like aripiprazole primarily manage psychosis, a mental disorder in which the mind loses touch with reality. Antidepressants treat other mental health conditions such as depression, insomnia or anxiety.
Since aripiprazole gained approval, a series of studies have looked into how it works with different antidepressants in treating major depressive disorder.
Studies that Combine Abilify with Antidepressants
- Combined with Zoloft
- A preliminary study published in the Journal of Clinical Psychopharmacology in 2011 found low doses of aripiprazole could increase the effectiveness of regular doses of Zoloft (sertraline) in treating major depressive disorder.
- Combined with Wellbutrin
- Preliminary research published in The Annals of Pharmacotherapy in 2008 found Abilify given in small doses at the same time as Wellbutrin (bupropion) resulted in rapid improvement in depressed patients.
- Combined with Prozac
- A 2008 examination of two studies found aripiprazole combined with an antidepressant such as Prozac is an effective strategy for some patients with major depressive disorder. The findings published in The Primary Care Companion to The Journal of Clinical Psychiatry related to patients who didn’t respond to antidepressants alone.
- Combined with Lexapro
- A seven-week study of Abilify combined with Lexapro (escitalopram) concluded the combination seems to be an effective and safe treatment for major depressive disorder. The study, however, included only 16 patients. Just 13 patients completed the study. Researchers published their findings in February 2009 in the Journal of Clinical Psychopharmacology.
Experts Question Benefits of Combination Treatment
Critics say the initial studies that won FDA approval for the combination treatment were too short or had too few participants. The FDA approval was based on studies that lasted just six weeks.
Dr. Steven Woloshin, a professor at Dartmouth Medical School, told Consumer Reports in 2010 that the trials failed to shed any light on the long-term effects of the combination treatment. Consumer Reports found aripiprazole is “just as likely to induce a bad side effect as it is to help rid depression.”
It reported that in one of the trials, the combination successfully treated depression in 25 percent of patients compared with 15 percent who had been given a placebo. But 26 percent of the Abilify group experienced a movement disorder called akathisia. Just 4 percent of those taking the placebo developed the same side effect.
Julie Donohue, an assistant professor at the University of Pittsburgh Graduate School of Public Health told Consumer Reports it’s only “a minority of patients who respond to the treatment.
” Meanwhile, aripiprazole can cause side effects such as the movement disorder tardive dyskinesia.
Compulsive Behavior and Other Side Effects
Atypical antipsychotics carry a lower risk of movement disorders, such as Parkinsonism. But they have a higher risk of metabolic side effects. These include increased blood sugar, blood pressure and cholesterol.
Abilify, particularly, is linked to several serious side effects. These range from weight gain to compulsive behaviors. These have been highlighted in news coverage. They are also the subject of hundreds of Abilify lawsuits.
Some side effects of aripiprazole include:
- Nausea
- Vomiting
- Insomnia
- Compulsive gambling
- Compulsive shopping
- Hypersexual activity
- Suicidal thoughts
- Weight gain
- Tardive dyskinesia (uncontrollable body movements)
Warnings and Precautions
Black box warnings are the most serious drug label warnings the FDA requires.
Abilify has two. One warns of suicidal thoughts among children, adolescents and young adults who take aripiprazole. The other warns elderly dementia patients who take the drug have a higher risk of death.
The label advises users to be cautious in operating heavy machinery or even driving until they know how aripiprazole affects them. It can make people sleepy. And researchers are unsure how it affects fetuses or breastfeeding infants. The label cautions pregnant and nursing women to talk to their doctor before starting the drug.
How and When to Take Abilify
Patients should ask their doctor how and when to take Abilify. They should not change how they take the medicine or stop taking it without first talking to their doctor.
Tablets come in six different dosages. The actual dose a doctor prescribes is based on the patient’s particular condition.
EXPAND
Abilify comes in 2 mg, 5 mg, 10 mg, 15 mg, 20mg and 30mg tablets.
The medication guide instructs patients to swallow the tablets whole. Patients can take the medicine with or without food.
A patient who misses a dose should take the missed dose as soon as they realize it. But if it’s almost time for the next dose, wait and take the next dose at the regular time.
Conditions and Recommended Dosages
| CONDITION | RECOMMENDED DAILY DOSAGE |
|---|---|
| Schizophrenia | Adults: 10 mg to 15 mg Adolescents (ages 13 to 17): 10 mg |
| Bipolar Mania | Adults: 15 mg (or 10 mg to 15 mg when used with lithium or valproate) Children (ages 10 to 17): 10 mg |
| Major Depressive Disorder (in combination with antipsychotic drugs) | Adults: 2 mg to 5 mg (with adjustments up to 15 mg) Children (ages 6 to 17): 5 mg to 10 mg |
| Tourette’s Disorder | Children (ages 6 to 18): 2 mg to 20 mg (depending on patient’s weight) |
| Irritability Associated with Autistic Disorder | Children (ages 6 to 17): 5 mg to 15 mg |
Source: Source: Drug Label
Doctors may start patients on as little as 2 mg at first and may increase the dose to as much as 30 mg a day depending on the patient’s circumstance and condition.
The maximum daily dose for the injection is 30 mg. Instructions say to wait at least two hours between doses.
Drug and Alcohol Interactions
Aripiprazole interacts with many other drugs, and these interactions can lead to serious complications. For example, the Prescribers’ Digital Reference says people should generally avoid taking Abilify with Adderall, an amphetamine doctors prescribe to treat attention deficit hyperactivity disorder.
Before taking Abilify, make sure your doctor and pharmacist are aware of all the drugs and supplements you already take.
Examples of drugs that interact with aripiprazole:
- Strong CYP3A4 inhibitors such as the antifungal drug itraconazole and the antibiotic clarithromycin
- Strong CyP2D6 inhibitors such as the anti-malaria drug quinidine and the antidepressants Prozac and Paxil
- Strong CYP3A4 inducers such as the anticonvulsant carbamazepine and the antibiotic rifampin
- Benzodiazepines such as lorazepam
- Hypertension drugs
This is not a full list of drugs that interact with aripiprazole.
The medication guide recommends patients make a list of all medicines they take and show it to their doctor before starting any new medicine.
Otsuka cautions people on aripiprazole to avoid drinking alcohol because it can worsen drowsiness caused by the medication. On the other hand, a 2008 study in Alcoholism: Clinical and Experimental Research found the drug may be useful in treating alcoholism because it decreased the euphoric effects of alcohol.
Abilify Facts
Please seek the advice of a medical professional before making health care decisions.
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Rispolept (risperidone) for autism: what is important for parents to know?
05.12.17
risks and the effect of a drug that is often prescribed for children at Autism
Author: Caroline Miller / Caroline Miller Source: Child Mind Institute
9000 9000
) is a drug often used to treat children with aggressive behavior or excessive irritability.
This drug was originally approved for the treatment of psychosis, but over the past twenty years, its use among children with autism or ADHD has increased dramatically. This is because Rispolept often allows children with severe behavioral problems to "calm down", which in turn helps them function at school and in the family. In some cases, the only alternative is for the child to be treated in a hospital.
However, Rispolept can cause serious side effects and it is very important to closely monitor the health of the child taking it. Parents should be aware that the doctor who prescribes Rispolept should carefully monitor the child's condition to ensure that he receives the best possible treatment.
Below is some basic information about Rispolept: why you need it, what are the potential side effects, and how to monitor your child while taking Rispolept.
Action of Rispolept
Rispolept belongs to new generation antipsychotics or atypical antipsychotics.
This is a class of antipsychotics that was approved in the 1990s for the treatment of psychotic symptoms in schizophrenia and bipolar affective disorder.
It is now more commonly used to reduce aggressiveness and irritability in patients with dementia and in children.
In children with autism, Rispolept may be prescribed to reduce behavioral problems such as aggression and self-harm, and has been approved for this very purpose. It may also be given to children with other disorders, such as attention deficit hyperactivity disorder (ADHD).
Generally, Rispolept and other atypical antipsychotics are needed only if the children's behavior is dangerous to themselves or others, or there is a risk of being excluded from the classroom or hospitalized for behavioral problems. In this case, Rispolept is used to make the child calmer. The use of the drug for this purpose has only been approved for children with autism, but a large body of research suggests that it is effective in reducing persistent behavioral problems in various disorders.
Why is the use of Rispolept considered controversial?
Taking Rispolept is considered controversial because its side effects can include significant weight gain, as well as metabolic, neurological and hormonal changes in the body.
Some experts are concerned that children may be put on the drug right away instead of alternative treatments, primarily behavioral therapy, that can solve the same problem without the risk of side effects.
Over the past few years, the media has covered many lawsuits from parents who claim they were not informed about how the side effects of risperidone could affect their children and that their children were not stopped when problems developed. The lawsuits included cases of boys who developed breasts due to elevated levels of the hormone prolactin, one of the rare side effects of risperidone.
Problems at school and at home
Dr. Wendy Moyal, child and adolescent psychiatrist at the Child Mind Institute (an American non-profit organization that specializes in children's mental health), describes a typical scenario for prescribing Rispolept because of aggressiveness or irritability, leading to severe behavioral problems.
Very often, these problem behaviors begin in early adolescence, says Dr. Moyal: "We're talking about extremely aggressive kids who push, shoved, punched, broke furniture."
If such children cannot control their emotions at all, they can be dangerous to other children, their own parents, and themselves. “Their parents may be so desperate they call 911,” says Dr. Moyal. Or the child has already been hospitalized by ambulance after a behavioral explosion at school.
Many experts believe that during a crisis like this, the doctor's best bet is to start treatment with risperidone to stabilize the situation.
However, outside of a crisis, experts recommend trying other approaches to correct problem behavior first.
Behavior Therapy
Most experts, including Dr. Moyal, emphasize that the possible causes of aggressive behavior must be carefully considered when deciding whether to prescribe a drug. Behavioral problems can have many different causes, including undiagnosed anxiety disorder, ADHD, learning disabilities, psychological trauma, and medical problems.
Treating these problems may be more effective at reducing unwanted behavior than antipsychotics.
If the child's behavior has not yet reached the crisis stage, experts recommend that as the first therapy, correction based on applied behavior analysis, including teaching parents how to properly respond to problem behavior and engage in its prevention.
Dr. Moyal says she herself usually recommends a behavioral therapy first or a drug at the same time as the behavioral therapy, depending on the level of risk.
Alternative drugs
In relatively stable situations, Dr. Moyal also prefers drugs that are more precise than Rispolept and have fewer side effects. For example, if a child has ADHD, stimulants (Ritalin or Adderall) or non-stimulant ADHD medications, such as clonidine or guanfacine, can reduce impulsive aggression. If a child has an obsessive-compulsive disorder, antidepressants (SSRIs) can reduce the depression or anxiety that triggers behavioral outbursts.
Dr. Moyal may try an atypical antipsychotic if other approaches fail. The neuroleptic aripiprazole (Abilify), which is often used for aggression, has also been approved for the treatment of irritability in children on the autism spectrum. Dr. Moyal often chooses it because it has fewer side effects than risperidone, including less weight gain and less endocrine disruption.
However, Dr. Moyal emphasizes that medication for autism should always be accompanied by behavioral therapy that includes parental education.
The medical community as a whole agrees. The survey, which was conducted among leading experts in the field of autism treatment, showed that each of them believes that drugs should not become a substitute for behavioral therapy.
The experts also note that if a child in crisis has been prescribed an atypical antipsychotic, then after stabilization, you can try to transfer him to another treatment. In Dr. Moyal's experience, children who receive behavioral therapy may find it easier to stop taking the drug later on.
“I prefer to use risperidone for a limited period of time until the crisis is over,” she explains. “And at the same time I organize behavioral therapy with parent education.”
Dr. Michael Milgham, child and adolescent psychiatrist at the Child Mind Institute, also uses the new generation of atypical antipsychotics to stabilize children in crisis situations.
However, he emphasizes that it can be dangerous to stop a child's medication until they have another support system, such as behavioral therapy.
“It's very important to know when to try to stop a child's drug—not to do it as soon as things get better,” explains Dr. Milgham. - The child's condition must be stable and he must receive regular support through other methods. Otherwise, you will only create more problems, and the child will end up in the emergency room.”
Side effects of Rispolept
Weight gain
The most common side effect of Rispolept is weight gain, which can happen very quickly.
In one study, the mean weight gain after 10.8 weeks of risperidone was 4.9kg compared to only 0.2 kg among children who took placebo. In a study of children who took risperidone for 2.9 years, one in three children were overweight or obese. The higher the dose of the drug, the greater was the weight gain associated with it.
Metabolic side effects
Rispolept can also cause so-called "metabolic abnormalities", including increased levels of sugar, lipids and triglycerides in the blood, which increases the risk of diabetes and heart disease later in life. These disorders are more common in children who are overweight or obese.
The atypical neuroleptics with the greatest risk of metabolic disorders are olanzapine (Zyprexa) and clozapine (Clozaril). Seroquel (Quetiapine) and Rispolept are somewhere in between. The lowest risk of such side effects exists for aripiprazole, ziprasidone and lurasidone.
Neurological side effects
Other possible side effects include a condition called tardive dyskinesia.
This dyskinesia is characterized by involuntary, repetitive movements, such as facial grimaces. The risk of tardive dyskinesia increases with higher dosage and prolonged treatment, and this condition may be permanent. The greatest risk of neurological side effects is associated with Rispolept, Zyprexa and Abilify.
Hormonal side effects
A side effect that has led to lawsuits against Johnson & Johnson, the manufacturer of Risperdal (one of the trade names for risperidone), is an increase in a hormone called prolactin. Elevated prolactin levels are called hyperprolactinemia. Normally, prolactin causes breast enlargement during pregnancy and breast milk production, as well as loss of bone strength. In boys, this hormone can interfere with the formation of sperm and cause breast enlargement, the so-called gynecomastia.
Studies show that when children take antipsychotics, prolactin levels rise during the first 6-8 weeks (in one study it was four times higher than among children taking placebo), but then it returns to normal.
It seems that high doses of risperidone, but not its long-term use, are associated with elevated prolactin levels.
However, not all children with elevated prolactin levels develop unwanted symptoms. Hyperprolactinemia is common (in 1-10% of patients), but associated symptoms such as gynecomastia are rare (in 0.1-1% of patients).
Among the new generation antipsychotics, Rispolept is associated with the greatest increase in prolactin levels, and Abilify with the least.
Tracking for side effects
Children taking Rispolept or other atypical antipsychotics should have regular check-ups with a doctor during treatment. Before starting the drug, you need to establish their initial height, weight, general health, levels of prolactin, fat and blood sugar.
During the first few months of treatment with Rispolept or another atypical antipsychotic, prolactin levels should be measured frequently. With an increased level of prolactin and the appearance of symptoms of hyperprolactinemia, it is recommended to reduce the dose and transfer the child to another drug.
If the child does not have symptoms of elevated prolactin levels, it is recommended that the child be examined annually if the child is planned to take the drug for an extended period, since the possible effect of prolonged elevated prolactin on fertility and bone development is unknown.
A team of Canadian researchers previously noted that blood tests and a physical examination of a patient in stable condition can be seen as a waste of time by busy doctors. However, given the possible negative consequences, they believe: "If the doctor is not ready to regularly examine the child for side effects, then he should not prescribe these drugs."
Working with your doctor
As with any drug, it is very important that you discuss any concerns with your doctor. Your doctor should be prepared to discuss with you the symptoms you are experiencing and explain your options for changing the dosage or changing the drug. If you feel that your child's doctor is not taking your concerns seriously, or that the doctor is not following drug selection and dosage recommendations, or that he is adding new drugs to those already taken, you should seek the opinion of another specialist.
If you think that your child should stop taking Rispolept, be sure to tell the doctor about it, discuss the pros and cons. Do not change the dose of the drug or stop taking it without consulting your doctor. Antipsychotics should not be discontinued immediately but should be tapered very gradually and the child monitored for withdrawal symptoms such as runny nose, diarrhea and abdominal pain. And remember, the main symptom to look out for is the return of the dangerous behavior for which the drug was prescribed.
See also:
Does a child with autism need to take medications
Autism and mental health
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Dmitry Yakimenko
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