Help With Tapering Off Abilify

In our latest question and answer, the pharmacist discusses common methods to safely taper (i.e. discontinue) Abilify (aripiprazole).

Question

What is the safest way to taper off 2mg of aripiprazole? Both my primary care and psychiatrist are now out of network, and I am experiencing negative side effects and can also no longer afford it due to a change in insurance.

Asked by Dani On Oct 13, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Oct 13, 2022
Last updated May 21, 2024

Key points

  • In most cases, it is recommended to taper (i.e. slowly decrease) your dose of Abilify to lessen the risk and severity of withdrawal symptoms.
  • Abilify tends to be better tolerated while discontinuing compared to other "antipsychotic" medications due to the long half-life.
  • Common tapering methods include decreasing your dose by about 25% per week and adjusting your dose as tolerated.
  • Depending on several factors (e.g. medical history, disease-state severity), a more conservative tapering approach may be recommended by your doctor (e.g. decreasing your dose by only 10% or week).
  • Abilify tablets can safely be split, and a liquid version of the drug (aripiprazole 1mg/mL) is available to help with your tapering regimen.

Answer

There are many different medication classes that are recommended to be tapered gradually, versus stopping abruptly. Slowly decreasing your medication over time (as opposed to stopping "cold turkey") tends to produce fewer side effects/withdrawal symptoms and is generally more tolerable for individuals. This is certainly true with the medication Abilify (aripiprazole).

What Is Abilify (Aripiprazole)?

Abilify is classified as an atypical antipsychotic and has a complex mechanism of action, working on a variety of receptors and neurotransmitters in the brain.

It is used to treat the symptoms of schizophrenia, episodes of mania or mixed episodes, and to treat depression when symptoms cannot be controlled by the antidepressant alone.

Antipsychotic drugs are typically recommended to be tapered slowly, over time, rather than stopping abruptly, to reduce the risk of severity of withdrawal reactions.

Why Tapering Abilify (Aripiprazole) Is Important

Abrupt discontinuation of Abilify can cause:

  • Recurrence of psychiatric symptoms
  • Withdrawal symptoms

Withdrawal symptoms from Abilify can be particularly difficult to deal with for many individuals. Potential withdrawal symptoms include:

  • Excess sweating or salivation
  • Flu-like symptoms
  • Tingling in the extremities
  • Respiratory distress
  • Gastrointestinal symptoms
  • Vertigo
  • Insomnia
  • Agitation

It is often difficult to determine whether or not any of the above symptoms are attributable to relapse of the mental condition being treated or to withdrawal reactions from the medication alone. However, if Abilify is slowly discontinued, it makes it easier to determine why certain symptoms are occurring and makes them less likely to happen overall.

If withdrawal symptoms happen, they typically begin about one week after beginning the taper and are generally the worst by 1-2 weeks. Withdrawal symptoms will not occur with everyone and most withdrawal symptoms are generally mild and go away quickly.

Abilify Is Less Likely To Cause Withdrawal Symptoms Compared To Other Drugs - But Tapering Is Still Recommended

In terms of atypical antipsychotics as a class, Abilify is thought to cause fewer withdrawal symptoms when compared to others in the class due to its extremely long half-life (i.e. time it takes for 50% of the drug to be metabolized in the body). One case report discussion commented as follows:

"[Abilify] Ariprazole and its active metabolite, dehydro-aripiprazole, have half-lives of 75 and 94 hours, respectively, and are seemingly unaffected by age or gender. Given these lengthy half-lives, it would seem less likely that aripiprazole would cause withdrawal symptoms.

Nevertheless, withdrawal symptoms are certainly a possibility for many, and tapering the medication for discontinuation is the prudent approach.

Abilify Tapering Strategies

In terms of tapering, approaches are mostly based on anecdotal evidence and there are often a variety of methods that can potentially be recommended for individuals. Certain patients may require different approaches than others, based on their medical history. It is always best to discuss what may work best for your individual case with your doctor.

  • One source recommends decreasing your dose by no more than 50% every two weeks. With this method, it will take at least one month to completely discontinue Abilify.
  • Other sources recommend decreasing your dose by about 25% per week and adjusting based on how you are tolerating your new dose. If withdrawal symptoms are particularly difficult to deal with, it is recommended to go back on your previously well-tolerated dose and decrease slower.
  • More conservative approaches have been tried as well. If you had more severe symptoms before starting Abilify, or you have had problems with breakthrough symptoms, a more prudent approach would be to decrease your dose by no more than 10% per week. With this method, it will take 2-3 months to completely discontinue the drug.

Again, it is important you speak with your doctor to determine the best taping method of Abilify for your particular situation.

Can You Cut/Split Pills To Help You Taper?

Abilify tablets can be safely split, which can be very helpful when trying to decrease your dose by a certain percentage.

Additionally, Abilify is available as an oral solution (1mg/mL), which may make it easier to dose in smaller increments while on a tapering schedule.

Final Words

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References

  • Switching between second-generation antipsychotics: why and how?, PubMed
  • Antipsychotics for the Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), PubMed
  • Aripiprazole Withdrawal: A Case Report, PubMed
  • Stopping and switching antipsychotic drugs, PubMed
  • A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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