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What
is Abilify?
Abilify (generic name aripiprazole) was approved for the treatment
of schizophrenia on November 15, 2002 by the U.S. Food and
Drug Administration. It represents a departure from the usual
mechanism of action of antipsychotic drugs.
How
is Abilify different from other antipsychotic medications?
All of the currently available medications for schizophrenia
block the ability of the neurotransmitter dopamine to bind
to a particular receptor in the brain called the D2 receptor.
The new, so-called atypical antipsychotic drugs like Zyprexa
and Risperdal are weaker D2 receptor blockers than the older
drugs like Haldol and Thorazine. By contrast, Abilify actually
has the ability, under certain circumstances, to stimulate
the D2 receptor and is technically called a "partial
D2 agonist." Animal studies suggest that when levels
of dopamine in the brain are low, Abilify may enhance the
dopamine effect by stimulating the D2 receptor. On the other
hand, these animal studies suggest that when dopamine levels
in the brain are too high, Abilify may actually switch its
role and block the ability of too much dopamine to get to
the receptor. Because it is now believed that some of the
negative and cognitive symptoms of schizophrenia may be due
to too little dopamine while the positive symptoms like hallucinations
and delusions are due to too much dopamine, a drug that could
regulate dopamine activity in this way would be beneficial.
However, it is very important to remember that we do not know
if Abilify actually works in this way in the human brain.
Like
the atypical antipsychotic drugs, Abilify also has effects
on some of the serotonin receptors. Again, it is not yet clear
if this is important in terms of how these drugs work in treating
schizophrenia.
Abilify
was studied in 1,238 patients with an acute relapse of schizophrenia
before the FDA approved it. In these studies, Abilify proved
to be superior to placebo for treating positive and negative
symptoms.
What
are the side effects of Abilify?
Abilify showed a relatively low rate of adverse side effects
in the clinical trials. The most common side effects were
headache, anxiety, and insomnia. Some patients also experience
a reduction in blood pressure when they get up from lying
or sitting, a phenomenon called "orthostatic hypotension."
This can cause dizziness and lightheadedness. In the short
term trials lasting four to six weeks the incidence of extrapyramidal
side effects (EPS) from Abilify was low and there was no weight
gain. However, longer-term experience is needed before it
can be certain that these will not be problems with Abilify
as they are with many other antipsychotic drugs.
What
is the standard dosage of Abilify?
Abilify can be given once daily, at any time of day. It comes
in 10, 15, 20 and 30 mg doses. The usual starting dose is
10 mg and most patients so far have been treated at between
10 and 15 mg daily. There are a few interactions between Abilify
and other drugs, such as fluoxetine (Prozac) and paroxetine
(Paxil), so it is important to tell your doctor about all
the other drugs you are taking before starting Abilify.
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