Medical Editor: John P. Cunha, DO, FACOEP
Abilify Maintena (aripiprazole) is an antipsychotic drug used for the treatment of schizophrenia. The most common side effect of Abilify Maintena is a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion (akathisia). Other side effects of Abilify Maintena include:
- blurred vision,
- weight gain,
- shaking (tremors), and
- redness/pain/swelling at the injection site.
Tell your doctor if you have serious side effects of Abilify Maintena including:
- trouble swallowing,
- restlessness (especially in the legs),
- seizures, or
- signs of infection (such as fever, persistent sore throat).
Abilify Maintena may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Tell your doctor if you develop symptoms of high blood sugar, such as increased thirst and urination.
Ability Maintena is administered under doctor's supervision via intramuscular injection. The recommended dose is 400 mg given monthly as a single injection. Dosage adjustments are required for missed doses. Abilify Maintena may react with anticonvulsant medications that contain carbamazepine, antifungal mediations that contain ketoconazole, quinidine, CNS depressants, or high blood pressure medications. Abilify Maintena has not been studied in pregnant women. Abilify Maintena is excreted in breast milk. Nursing mothers should consult their doctors before breastfeeding.
Our Abilify Maintena (aripiprazole) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Dizziness, lightheadedness, drowsiness, tiredness, blurred vision, weight gain, shaking (tremors), and redness/pain/swelling at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: fainting, trouble swallowing, restlessness (especially in the legs), seizures, signs of infection (such as fever, persistent sore throat).
This medication may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Rarely, very serious conditions such as diabetic coma may occur. Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.
This medication may rarely cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any unusual uncontrolled movements (especially of the face, mouth, tongue, arms, or legs).
This medication may rarely cause a serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you develop any of the following: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, change in amount of urine.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Abilify Maintena (Aripiprazole Extended-Release Injectable Suspension)
The following adverse reactions are discussed in more detail in other sections of the labeling:
- Increased Mortality in Elderly Patients with Dementia -Related Psychosis Use [see BOXED WARNING and WARNINGS AND PRECAUTIONS]
- Cerebrovascular Adverse Reactions, Including Stroke in Elderly Patients with Dementia-Related Psychosis [see BOXED WARNING and WARNINGS AND PRECAUTIONS]
- Neuroleptic Malignant Syndrome [see WARNINGS AND PRECAUTIONS]
- Tardive Dyskinesia [see WARNINGS AND PRECAUTIONS]
- Metabolic Changes [see WARNINGS AND PRECAUTIONS]
- Pathological Gambling and Other Compulsive Behaviors [see WARNINGS AND PRECAUTIONS]
- Orthostatic Hypotension [see WARNINGS AND PRECAUTIONS]
- Leukopenia, Neutropenia, and Agranulocytosis [see WARNINGS AND PRECAUTIONS]
- Seizures [see WARNINGS AND PRECAUTIONS]
- Potential for Cognitive and Motor Impairment [see WARNINGS AND PRECAUTIONS]
- Body Temperature Regulation [see WARNINGS AND PRECAUTIONS]
- Dysphagia [see WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Safety Database Of ABILIFY MAINTENA And Oral Aripiprazole
Oral aripiprazole has been evaluated for safety in 16,114 adult patients who participated in multiple-dose, clinical trials in schizophrenia and other indications, and who had approximately 8,578 patient-years of exposure to oral aripiprazole. A total of 3,901 patients were treated with oral aripiprazole for at least 180 days, 2,259 patients were treated with oral aripiprazole for at least 360 days, and 933 patients continuing aripiprazole treatment for at least 720 days.
ABILIFY MAINTENA has been evaluated for safety in 2,188 adult patients in clinical trials in schizophrenia, with approximately 2,646 patient-years of exposure to ABILIFY MAINTENA. A total of 1,230 patients were treated with ABILIFY MAINTENA for at least 180 days (at least 7 consecutive injections) and 935 patients treated with ABILIFY MAINTENA had at least 1 year of exposure (at least 13 consecutive injections).
The conditions and duration of treatment with ABILIFY MAINTENA included double-blind and open-label studies. The safety data presented below are derived from the 12-week double-blind placebo-controlled study of ABILIFY MAINTENA in adult patients with schizophrenia.
Adverse Reactions With ABILIFY MAINTENA
Most Commonly Observed Adverse Reactions In Double-Blind, Placebo-Controlled Clinical Trials In Schizophrenia
Based on the placebo-controlled trial of ABILIFY MAINTENA in schizophrenia, the most commonly observed adverse reactions associated with the use of ABILIFY MAINTENA in patients (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) were increased weight (16.8% vs 7.0%), akathisia (11.4% vs 3.5%), injection site pain (5.4% vs 0.6%) and sedation (5.4% vs 1.2%).
Commonly Reported Adverse Reactions In Double-Blind, Placebo-Controlled Clinical Trials In Schizophrenia
The following findings are based on the double-blind, placebo-controlled trial that compared ABILIFY MAINTENA 400 mg or 300 mg to placebo in patients with schizophrenia. Table 7 lists the adverse reactions reported in 2% or more of ABILIFY MAINTENA-treated subjects and at a greater proportion than in the placebo group.
Table 7: Adverse Reactions in ≥ 2% of ABILIFY
MAINTENA-Treated Adult Patients with Schizophrenia in a 12-Week Double-Blind,
|System Organ Class
|Percentage of Patients Reporting Reactiona|
|General Disorders and Administration Site Conditions|
|Injection Site Pain||5||1|
|Infections and Infestations|
|Upper Respiratory Tract||4||2|
|Musculoskeletal And Connective Tissue Disorders|
|Nervous System Disorders|
|Respiratory, Thoracic And Mediastinal|
|a This table does not include adverse reactions which had an incidence equal to or less than placebo.|
Other Adverse Reactions Observed During The Clinical Trial Evaluation Of ABILIFY MAINTENA
The following listing does not include reactions: 1) already listed in previous tables or elsewhere in labeling, 2) for which a drug cause was remote, 3) which were so general as to be uninformative, 4) which were not considered to have significant clinical implications, or 5) which occurred at a rate equal to or less than placebo.
Reactions are categorized by body system according to the following definitions: frequent adverse reactions are those occurring in at least 1/100 patients; infrequent adverse reactions are those occurring in 1/100 to 1/1000 patients; rare reactions are those occurring in fewer than 1/1000 patients:
Blood and Lymphatic System Disorders: rare -thrombocytopenia
Endocrine Disorders: rare -hypoprolactinemia
Eye Disorders: infrequent -vision blurred, oculogyric crisis
General Disorders and Administration Site Conditions: frequent -fatigue, injection site reactions (including erythema, induration, pruritus, injection site reaction, swelling, rash, inflammation, hemorrhage), infrequent -chest discomfort, gait disturbance, rare-irritability, pyrexia
Hepatobiliary Disorders: rare -drug induced liver injury
Immune System Disorders: rare -drug hypersensitivity
Infections and Infestations: rare -nasopharyngitis
Investigations: infrequent -blood creatine phosphokinase increased, blood pressure decreased, hepatic enzyme increased, liver function test abnormal, electrocardiogram QT-prolonged, rare blood triglycerides decreased, blood cholesterol decreased, electrocardiogram T-wave abnormal
Metabolism and Nutrition Disorders: infrequent -decreased appetite, obesity, hyperinsulinemia
Psychiatric Disorders: frequent -anxiety, insomnia restlessness, infrequent-agitation, bruxism, depression, psychotic disorder, suicidal ideation, rare -aggression, hypersexuality, panic attack
Renal and Urinary Disorders: rare -glycosuria, pollakiuria, urinary incontinence
Vascular Disorders: infrequent -hypertension
An examination of population subgroups was performed across demographic subgroup categories for adverse reactions experienced by at least 5% of ABILIFY MAINTENA subjects at least twice rate of the placebo (i.e., increased weight, akathisia, injection site pain, and sedation) in the double-blind placebo-controlled trial. This analysis did not reveal evidence of differences in safety differential adverse reaction incidence on the basis of age, gender, or race alone; however, there were few subjects ≥ 65 years of age.
Injection Site Reactions Of ABILIFY MAINTENA
In the data from the short-term, double-blind, placebo-controlled trial with ABILIFY MAINTENA in patients with schizophrenia, the percent of patients reporting any injection site-related adverse reaction (all reported as injection site pain) was 5.4% for patients treated with gluteal administered ABILIFY MAINTENA and 0.6% for placebo. The mean intensity of injection pain reported by subjects using a visual analog scale (0=no pain to 100=unbearably painful) approximately one hour after injection was 7.1 (SD 14.5) for the first injection and 4.8 (SD 12.4) at the last visit in the double-blind, placebo-controlled phase.
In an open-label study comparing bioavailability of ABILIFY MAINTENA administered in the deltoid or gluteal muscle, injection site pain was observed in both groups at approximately equal rates.
Extrapyramidal Symptoms (EPS)
In the short-term, placebo-controlled trial of ABILIFY MAINTENA in adults with schizophrenia, the incidence of reported EPS-related events, excluding events related to akathisia, for ABILIFY MAINTENA-treated patients was 9.6% vs. 5.2% for placebo. The incidence of akathisia-related events for ABILIFY MAINTENA-treated patients was 11.5% vs. 3.5% for placebo.
Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups. In the short-term, placebo-controlled trial of ABILIFY MAINTENA in adults with schizophrenia, the incidence of dystonia was 1.8% for ABILIFY MAINTENA vs. 0.6% for placebo.
In the short-term, placebo-controlled trial of ABILIFY MAINTENA in adults with schizophrenia, the incidence of neutropenia (absolute neutrophil count ≤ 1.5 thous/μL) for ABILIFY MAINTENA-treated patients was 5.7% vs. 2.1% for placebo. An absolute neutrophil count of < 1 thous/μL (i.e. 0.95 thous/μL) was observed in only one patient on ABILIFY MAINTENA and resolved spontaneously without any associated adverse events [see WARNINGS AND PRECAUTIONS]
Adverse Reactions Reported In Clinical Trials With Oral Aripiprazole
The following is a list of additional adverse reactions that have been reported in clinical trials with oral aripiprazole and not reported above for ABILIFY MAINTENA:
Cardiac Disorders: palpitations, cardiopulmonary failure, myocardial infarction, cardiorespiratory arrest, atrioventricular block, extrasystoles, angina pectoris, myocardial ischemia, atrial flutter, supraventricular tachycardia, ventricular tachycardia
Immune System Disorders: hypersensitivity
Injury, Poisoning, and Procedural Complications: heat stroke
Psychiatric Disorders: loss of libido, suicide attempt, hostility, libido increased, anger, anorgasmia, delirium, intentional self injury, completed suicide, tic, homicidal ideation, catatonia, sleep walking
Skin and Subcutaneous Tissue Disorders: rash (including erythematous, exfoliative, generalized, macular, maculopapular, papular rash; acneiform, allergic, contact, exfoliative, seborrheic dermatitis, neurodermatitis, and drug eruption), hyperhidrosis, pruritus, photosensitivity reaction, alopecia, urticaria
The following adverse reactions have been identified during post-approval use of oral aripiprazole or ABILIFY MAINTENA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: occurrences of allergic reaction (anaphylactic reaction, angioedema, laryngospasm, pruritus/urticaria, or oropharyngeal spasm), pathological gambling, hiccups and blood glucose fluctuation.
Read the entire FDA prescribing information for Abilify Maintena (Aripiprazole Extended-Release Injectable Suspension)