What time of day to take abilify

Why should you take aripiprazole in the morning?

Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 16, 2022.

Aripiprazole is one of those medications that can cause sleepiness in some people and insomnia (an inability to get to sleep) in others. Aripiprazole should be preferably taken in the morning, especially if it keeps you awake at night. Research also suggests taking it at night may antagonize D2 dopamine receptors and disrupt 24h rhythms in insulin release, possibly exacerbating metabolic dysfunction. In one study of 143 people (90 of whom took aripiprazole in the morning and 53 who took it at night) reported:

A significant decrease in HDL cholesterol (“good” cholesterol) in those who took aripiprazole at night but no change in those who took it in the morning

A non-significant trend toward higher serum triglycerides in those who took aripiprazole at night
No difference in HbA1c, BMI, total cholesterol, LDL cholesterol, or blood pressure.

The most important thing is to take your aripiprazole. If it makes you sleepy or you are more likely to remember to take it, take it at night.

References

Takaki M. Aripiprazole as Monotherapy at Bedtime Was Effective for Treatment of Two Cases of Obsessive-Compulsive Disorder and Insomnia. The Journal of Neuropsychiatry and Clinicl Neurosciences. 2014 (26):3 https://doi.org/10.1176/appi.neuropsych.13100245
Danielle A. Chipchura1, Zachary Freyberg2, Corey Edwards1, Susan G. Leckband1 and Michael J. McCarthy1,3. Does the Time of Drug Administration Alter the Metabolic Risk of Aripiprazole? Front. Psychiatry, 11 October 2018 Sec. Psychological Therapy and Psychosomatics https://doi.org/10.3389/fpsyt.2018.00494

Drug information

Aripiprazole Information for Consumers
Aripiprazole Information for Healthcare Professionals (includes dosage details)
Side Effects of Aripiprazole (detailed)

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Medical Disclaimer

Taking ABILIFY® (aripiprazole)

As with any medicine, it's important to take ABILIFY (aripiprazole) exactly as directed, for as long as your doctor prescribes it. Here is some information that can help.

Talk to your doctor about all your medicines

Be sure to tell your doctor about any other medications you're on including prescription medicines, non-prescription medicines, herbal supplements, and vitamins. ABILIFY may interact with other medications, which could affect the way that each one works. Your doctor can tell you if it is safe to take ABILIFY with your other medicines. He or she can also tell you if you should start or stop any other medications while you’re on ABILIFY.

If you are using a

Savings Card to pay as little as $5 per month,^* tell your pharmacist you want brand-name ABILIFY for every refill

Remember: your Savings Card only works for brand-name ABILIFY. Present your Savings Card (along with your prescription for brand-name ABILIFY) to your pharmacy. If your prescription was sent electronically to your pharmacy, check to make sure your ABILIFY prescription was not switched to a generic option. If it was switched, ask the pharmacist to reprocess your prescription for brand-name ABILIFY. Then, each time you pick up, check your prescription bottle and receipt to ensure you received brand-name ABILIFY and paid $5.* Pharmacy rules or local laws may apply.

*Terms and conditions apply. Assumes one 30-day supply prescription per month. If more than one prescription is filled in a calendar month, you may pay more than $5 in that month. See other terms and conditions.

Report any side effects to your doctor

Everyone responds differently to medication. Serious side effects have been reported with ABILIFY. Take note of any side effects you experience, and report them to your doctor. This will help your doctor understand how to manage your side effects.

Call your doctor if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

Thoughts about suicide or dying
Attempts to commit suicide

New or worse depression
New or worse anxiety
Feeling very agitated or restless
Panic attacks
Trouble sleeping (insomnia)
New or worse irritability
Acting aggressive, being angry, or violent
Acting on dangerous impulses
An extreme increase in activity and talking (mania)
Other unusual changes in behavior or mood

Know what to avoid while taking ABILIFY

Do not drive, operate heavy machinery, or do other dangerous activities until you know how ABILIFY affects you. ABILIFY may make you drowsy.
Avoid getting over-heated or dehydrated
1. Do not over-exercise
2. In hot weather, stay inside in a cool place if possible.
3. Stay out of the sun. Do not wear too much or heavy clothing
4. Drink plenty of water

Stay on schedule

ABILIFY is usually taken once a day, with or without food. You may want to ask your doctor for advice on what time of day to take ABILIFY. But remember to always take ABILIFY as directed by your doctor.

Taking ABILIFY regularly may help you get the best results from your treatment. And to help yourself stay on your prescribed schedule, there are a few things you may find helpful:

Try making your medication part of your daily routine
Mark your dose on a calendar to-do list
Use a childproof weekly pillbox to keep your ABILIFY pills in order
Ask a friend or family member to help remind you

Don't stop taking ABILIFY without talking to your doctor

Even if you start to feel better, it's important to keep taking ABILIFY as prescribed by your doctor. It may take time to feel the effect of ABILIFY, so don't change your routine or stop taking ABILIFY without talking to your doctor first.

Know what to do if you miss a dose

If you miss a dose, take your ABILIFY as soon as you remember. However, if it's almost time for your next dose, skip the missed dose and continue your regular schedule. Do not take a double dose. If you miss several doses, talk to your doctor right away.

Keep your doctor informed

Consider using a journal to record how you're feeling each day so you can compare it to how you felt before taking ABILIFY. Be sure to share your results with your doctor, including any side effects. This way, your doctor will better understand what effect your treatment is having and be able to adjust it if necessary.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if ABILIFY will harm your unborn baby. If you are breast feeding or plan to breast feed, talk to your doctor.

Make the most of your support system

Family and friends can provide a helping hand and be a much-needed source of encouragement. Don't be afraid to reach out, and accept support when you need it.

Questions? Find answers in this FAQ or call 1-888-922-4543

Rispolept (risperidone) for autism: what is important for parents to know?

05.12.17

RISKS AND ACTIVITION OF THE ATISTIC OFFICE ATISM

Author: Caroline Miller / Caroline Miller
Source: Child Mind Institute

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) 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.

The use of aripiprazole (Abilify) in the treatment of schizophrenia and schizoaffective disorders - Psychiatry and Psychopharmacotherapy. P.B. Gannushkin №01 2009

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Author:O.P.Vorsina, E.V.Sapozhnikova, R.O.Yaroslavtsev, I.V.Trotsenko

Regional Clinical Psychiatric Hospital No. 1, Irkutsk

Page numbers in the issue: 34-36

In recent decades, there has been an unprecedented increase in the use of new antipsychotic drugs, which for the most part do not have the disadvantages of classical drugs. Currently, atypical antipsychotics are understood to mean drugs that do not cause extrapyramidal side effects and eliminate both positive and negative symptoms. Aripiprazole is currently the only atypical antipsychotic that is a partial agonist of dopamine D2 receptors, i.e. under conditions of dopaminergic hyperactivity, it acts as a functional antagonist, and under conditions of dopamine deficiency, it acts as a functional agonist. This ability to balance the content of dopamine is of particular therapeutic value in the treatment of schizophrenia, as it provides the ability to eliminate side effects caused by the blockade of dopamine receptors.

In recent decades, there has been an unprecedented increase in the use of new antipsychotic drugs, which for the most part do not have the disadvantages of classical drugs. Currently, atypical neuroleptics are drugs that do not cause extrapyramidal side effects and eliminate both positive and negative symptoms.
Aripiprazole is currently the only atypical antipsychotic that is a partial agonist of dopamine D2 receptors, i.e. under conditions of dopaminergic hyperactivity, it acts as a functional antagonist, and under conditions of dopamine deficiency, it acts as a functional agonist. This ability to balance the content of dopamine is of particular therapeutic value in the treatment of schizophrenia, as it provides the ability to eliminate side effects caused by the blockade of dopamine receptors.
The aim of the study was to evaluate the efficacy, safety and tolerability of aripiprazole (Abilify®) in patients with paranoid schizophrenia and schizoaffective disorder.

The efficacy of aripiprazole was assessed using the PANSS psychometric scale and the Clinical Global Impression Scale. The safety of the drug and side effects were assessed by recording all adverse events that occurred during treatment, as well as using the UKU side effect rating scale. The scales were assessed before the start of therapy, and then weekly. In accordance with the inclusion criteria, patients had to have at least 4 points on the CGI scale and at least 60 points on the PANSS scale (Fig. 1).
The study did not include patients with severe somatic, oncological diseases, women during pregnancy and lactation.
The study included 16 patients - 11 (68.8%) men and 5 (31.2%) women, the mean age was 26.75±10.8 years (from 18 to 55 years). For the first time 14 (87.5%) patients were hospitalized, for the 2nd and 3rd times - 1 (6.25%) each person. In accordance with the ICD-10, the patients were distributed: paranoid schizophrenia with episodic course (including paroxysmal-progredient) - F20.x1 - 11 people, schizoaffective disorder (manic, depressive, mixed types) - F25.0, F25.1, F25 .2 - 5 people.
The duration of treatment with aripiprazole was 4–8 weeks. A six-week course of therapy (42 days) was completed by 13 people, by the end of the 8th week - 5 people. Since 16 patients had at least 4 evaluation points, all patients who participated in the study were included in the final statistical analysis.

The dose of aripiprazole ranged from 15 to 30 mg per day, with an average maximum daily dose of 24.8 mg (Table 1).

The dynamics of psychopathological symptoms according to the PANSS scale (including the total score, subscales of positive, negative disorders, general psychiatric symptoms) during 8-week therapy with aripiprazole is shown in fig. 12; in table. 2.

The proportion of responders to aripiprazole monotherapy for episodic paranoid schizophrenia and schizoaffective disorder was 93.8% (with a decrease in the daily PANSS score by at least 30% from the pre-treatment level). Statistically significant favorable changes in the severity of the overall psychopathological, positive, negative and total scores on the PANSS scale began to be recorded from the 14th day of therapy and increased as aripiprazole therapy was continued.
By the end of the 8th week of therapy, the significance of differences in the total assessment when compared with the baseline before treatment was maximum: 62. 0±24.04 and 132.38±24.95 points, respectively (p<0.001).

In accordance with the CGI scale, a significant and significant improvement was noted in 25 and 43.8% of cases, respectively, a slight improvement in 18.8%, no change in 6.2% and deterioration in 6.2% observations (Fig. 3).
The clinical activity profile of aripiprazole was characterized by a positive effect on productive psychopathological and affective symptoms. From the 2nd week of therapy, hallucinations became less intense, the feeling of alienation of one's own thoughts disappeared, it became possible to arbitrarily control them, delusional experiences became deactivated.

The effect of the drug on confusion, anxiety, affective emotional charge, aggressive behavior of patients was noted.
From the 3rd week of therapy with aripiprazole, the activity of patients increased, they became more contact, tolerant, relations with relatives improved.
Undesirable side effects with aripiprazole monotherapy were detected in 4 (25%) patients.

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