Doctors are arbitrarily prescribing Abilify, promoted as an "adjunct" or add-on to antidepressants, when a patient doesn't respond well to an antidepressant -- instead of reducing or eliminating the antidepressant.
This means you may experience no benefit or adverse effects from two drugs rather than one, and have to risk withdrawal from tapering either of them.
Thinking they're taking "baby" doses, people are going cold turkey off Abilify and suffering withdrawal symptoms.
While the Abilify dosage might seem small compared to other drugs, milligram for milligram, it is a powerful drug. Like any other psychiatric drug, do not suddenly quit Abilify at any dose.
Major Depressive Disorder
PO Recommended starting dosage for patients already receiving an antidepressant is 2 to 5 mg/day. Gradually make dose adjustments of up to 5 mg/day at intervals of no less than 1 wk. Efficacy of adjunctive therapy was established within the range of 2 to 15 mg/day.
Concurrent Use of Strong CYP3A4 (eg, ketoconazole) or CYP2D6 (eg, fluoxetine, quinidine) Inhibitors [many antidepressants inhibit or block the liver enzyme CYP2D6]
PO Reduce the usual dose of aripiprazole by 50%. Increase the dose when the CYP3A4 or CYP2D6 inhibitor is discontinued.
Approximately 25% of a single oral dose is excreted in urine (less than 1% unchanged) and 55% in feces (approximately 18% as unchanged drug). Elimination half-life is 75 h (aripiprazole) and 94 h (dehydroaripiprazole).
Aripiprazole has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence. In physical dependence studies in monkeys, withdrawal symptoms were observed upon abrupt cessation of dosing.
If you are taking 2-15mg per day of Abilify, you are taking a full dose.
Depending on the sensitivity of your nervous system, even 2mg might be difficult to quit. To be safe, taper off at 10% per month, like other psychiatric drugs, to let your nervous system accommodate.
See Why taper by 10% of my dosage?
Tablets and oral solution
Abilify comes in these dosages (from FDA info at http://www.drugs.com/pro/abilify.html):
- Tablets 2 mg
- Tablets 5 mg
- Tablets 10 mg*
- Tablets 15 mg*
- Tablets 20 mg
- Tablets 30 mg
- Abilify solution, oral 1 mg/mL 150-mL bottle NDC 59148-013-15
*also available in DISCMELT® Orally Disintegrating Tablets
From http://www.drugs.com...piprazole.html:"Oral solution may be substituted for tablets on a mg-per-mg basis up to a 25 mg dose. Patients receiving 30 mg tablets should receive 25 mg of the solution."
From http://www.drugs.com/abilify.html :
The liquid form (oral solution) of Abilify may contain up to 15 grams of sugar per dose. Before taking Abilify oral solution, tell your doctor if you have diabetes. The orally disintegrating tablet form of this medicine may contain over 3 milligrams of phenylalanine per tablet. Before taking Abilify Discmelt, tell your doctor if you have phenylketonuria.
According to official US information at http://dailymed.nlm....?archiveid=3650, peak plasma concentrations occur within 3 to 5 hours of taking a tablet or the liquid. More of the drug is absorbed via the liquid form.
Since the dosage is very low, the best way to taper would be to use the oral solution. Use a tiny 1mL syringe to measure dosages less than 1mg, to hundredths of a milligram.
Cutting up tablets
If you are taking the tablets, you can cut them up. (See From Current Psychiatry 2006: Tablets that may be split ) For precise dosing, weigh the pieces with a digital scale.
Use the Abilify liquid suspension
Titrating using a liquid is very good for very small measured decreases in dosage, allowing more precise measurements.
Dissolving tablets in water
I have no information about this. As near as I can tell, the ordinary Abilify tablet is insoluble in water (http://www.aapsj.org...2009-003188.PDF ). You may be able to make a solution with the Abilify DISCMELT® Orally Disintegrating Tablets (available in 10mg and 15mg dosages); I don't know what the stability would be -- how long the liquid would be good.
For general instructions about making your own liquid http://survivinganti...ts-or-capsules/
About solubility or insolubility, our esteemed member Rhi, a lab technician, has made many, many homemade liquids:
.... I just wanted to toss in my usual bit on the subject of making preparations for liquid tapering, which is: I personally don't worry about solubility.
None of the meds I'm tapering are actually soluble in water. But the pills dissolve into small enough particles that I can stir them up and keep them suspended in water while I measure them out, and that seems to work for me. I stir well before I measure, I stir a little while pipetting them up; I dissolve the pills in glass and pipette out of glass so that I can see visually how evenly everything is suspended, and that's good enough for me.
I use water as a medium because I like it that I can easily see for myself how evenly the little particles are suspended or if they seem to be settling out. Also because it's handy and cheap and I don't have to carry it with me if I travel.
Mostly I would just say, I don't think it really matters if the medication is soluble in whatever vehicle you're using, as long as it can be evenly distributed. What really matters is that it be evenly distributed and that your method be repeatable and consistent.
For a drug that is "insoluble" in water, a pharmaceutical liquid to make suspensions might be the best option, see http://survivinganti...ke-suspensions/
Have a compounding pharmacy make a liquid for tapering
Compounding pharmacies can make a liquid from the tablets. You will need a prescription written for the custom compound. The only drawback is this can be quite expensive.
Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.
If your doctor prescribes liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.
Edited by Altostrata, 19 July 2015 - 11:20 AM.