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Altostrata

Tips for tapering off Abilify (aripiprazole)

18 posts in this topic

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.

http://www.drugs.com/ppa/aripiprazole.html
 

Major Depressive Disorder
Adults

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.

 
Also see US FDA information at http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=3650

Abilify has a very long half-life but still needs tapering, see http://www.drugs.com/pro/Abilify.html
 

Elimination

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/ppa/aripiprazole.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.nih.gov/dailymed/archives/fdaDrugInfo.cfm?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/abstracts/AM_2009/AAPS2009-003188.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://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-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://survivingantidepressants.org/index.php?/topic/3068-pharmaceutical-liquids-to-make-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
updated

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This was one of the many adjunctive therapies I was on over the years. It seemed to help slightly for about 6 months, then pooped out. An MSW friend who works in a state hospital said the brief effect followed by poop out is common with Abilify although I don't know why. I tapered from 10 to 5 to 2 over a few weeks, so not far from CT. I don't recall remarkable withdrawal, but that timeframe is all a blur.

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Hi there

 

Just looking for some information on possible withdrawal symptoms from Abilify.

 

My son took his last dose of Abilify (2.5mg) on Saturday August 4th 2012.

 

He's been on a slower taper.

 

Per his neurologist he shouldn't have any withdrawal symptoms, however she's never taken Abilify, so I thought it best to check in with folks who have.

 

My son is 17, non verbal and profoundly disabled, so trying to see if any withdrawal symptoms are happening will be tricky.

 

How long does Abilify stay in the system after the final dose?

 

What are some typical withdrawal symptoms he could experience?

 

How long do the withdrawal symptoms stay, before normal life resumes?

 

Thanks for your help and insight!

gail

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Hello and thanks for the quick reply...

 

His highest dose was 20 mg. He started a slower taper.

 

15 mg for 10 days

10 mg for 10 days

7.5 mg for 10 days

5 mg for 10 days

2.5 for 10 days.

 

All under the direction of his Neurologist.

 

I just successfully tapered off of Imimprine, but had 11 days of withdrawals. Ugh..

 

His neurologist has never taken Abilify, thus she can't speak from experience if there are any withdrawals.

 

I do realize everyone will have a different experience.

 

Just wanted some insight!

 

We usually advise 10% cuts off the previous dose for psychotropics, with one month holds. Some people can taper more rapidly while others go more slowly. The taper schedule above is very fast. Alto, our admin, will advise you how to proceed. Abilify comes in a liquid which makes it possible to take small cuts. Most docs are woefully uninformed when it comes to helping folks come off meds. I wonder if your son is acting differently, in a way that would suggest he is in discomfort?

 

Are you still having withdrawal symptoms from Imiparmine? How long ago did you take your last dose?

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The tapering was given by my son's neurologist. I told her I wanted a slow, safe taper, thus the schedule was given.

 

I'm no longer on Imimiprine. My taper was over 5 months long!

 

I was on the medication for over 20 years. My dose went from 200 mg per day, down to 25 mg on my last dose.

 

However, I did have withdrawals, which I totally was not expecting. I thought doing a slow taper, my body/mind/brain would adjust accordingly.

 

Thus, my inquiry about possible withdrawal affects for my son who is now off Abilify.

 

gial

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The tapering was given by my son's neurologist. I told her I wanted a slow, safe taper, thus the schedule was given.

Hi Gail, The taper was very percipitous. Most docs do not know how to taper safely because they get their info from the drug companies whose vested interest it is to hold back on the difficulties involved. Some people can come off easily, but others have much difficulty. As this is a situation in which your son could not tell you if he is in distress a slow safe taper is important. Again, Alto will advise.

 

I'm no longer on Imimiprine. My taper was over 5 months long! I was on the medication for over 20 years. My dose went from 200 mg per day, down to 25 mg on my last dose.

 

However, I did have withdrawals, which I totally was not expecting. I thought doing a slow taper, my body/mind/brain would adjust accordingly.

Many people take two years or more to come off ADs. I am completing what will have been a more than 2 year taper to get off benzos, and will be doing the same length for Lyrica. All psychotropics have a similar withdrawal profile. Your taper was fast. Some people can come off more quickly, but those whose tapers are too abrupt can have withdrawal symptoms for months, sometimes years. I'm glad you did not taper more quickly as ADs' post withdrawal symptoms can reemerge long after you think they have gone away.

 

Thus, my inquiry about possible withdrawal affects for my son who is now off Abilify.

You are being very caring. Sounds like your experience with Imipramine may help spare your son considerable distress.

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Hello, bunny42.

 

Well, at least it's a taper. He may not suffer withdrawal symptoms. Whether someone suffers withdrawal is highly individual.

 

Yes, like all psychiatric drugs, Abilify can have withdrawal symptoms. Since it's fairly new, this is not well known.

 

We have several members who've experienced Abilify withdrawal. Go to the Introductions forum, use Search in the upper right of the page to look for "Abilify" (no quotes).

 

If you see agitation, you might reinstate at perhaps 1mg or 2mg to see if that helps, stabilize for a couple of weeks, and taper more slowly from there with a tiny 1mL oral syringe.

 

See Tips for tapering off Abilify (aripiprazole)

 

Also see FDA info at http://www.drugs.com/pro/abilify.html

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.

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I guess I was also looking to see if withdrawals do happen, how long after last dose.

 

When I took my last dose of Imimprimine, I didn't get withdrawals until 5 days later, and then they lasted for 11 days. ugh..

 

So since my son just stopped Abilify Saturday August 4th, he potentially could experience something in the next week or so.

 

Darn it! :)

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bunny, it could be your son's taper was sufficient.

 

Withdrawal symptoms usually show up within a week or two, but since his communication skills are limited, you might not know about the more subtle ones, like dizziness.

 

Sorry to hear of your withdrawal symptoms. If your taper had been a little more gradual, you might not have had any, but it's good that they lasted only a couple of weeks.

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Hi again Gail..

 

I worked with blind/deaf profoundly retarded adolescents who had Cerebral Palsy. If one of them had withdrawal, and I was watching for it, I would have been able to tell something was wrong. I don't know if this situation is at all close to what you are dealing with with your son, but there really are cues. The restlessness would be unmistakable.

 

I'm sorry if I introduced complications needlessly. We see so much of the worst case scenario on this site, it's not so hard to lose track of the fact that not everyone goes thru the whole deal.. and your son is still young and may well be just fine. Seriously.. you did good to look for info preventatively.

 

Be well.. and don't worry quite so much, K? Schuyler

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Hello. I just wanted to give some recent information about Abilify to those still taking this drug. The Abilify oral solution is being discontinued this year (5/15/2015). This means, for those of us who were wanting to do the slower taper using the liquid and a 1ml oral syringe, that this will be significantly harder, if not impossible. I guess a compounding pharmacy could still make liquid solution out of the pills and formulate a dose, but I'm not really sure. Also, the orally disintegrating tablets are being discontinued this year. All that is left are the solid pills. Even a 2 or 1mg dose of Abilify, when abruptly stopped, can cause withdrawal. A word to the wise. Hope this update is useful.

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Thank you very much for this update. Let us know what the pharmacist says, can it be compounded only by them or can users make an oral solution? According to Alto's first post, she could not find any info on making a liquid and it seems to be insoluable in water but quotes Rhi as showing there are ways around this.

 

You can post what you find in this thread. Members who are tapering this need to be prepared.

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Hello. I want to explain another way to taper off Abilify (or other crushable drugs). 

I’m using a dry product like powdered sugar or cocoa powder, a digital scale (0.001g Resolution) and a pill crusher.
I started tapering off Abilify from 20 mg and now I’m taking 9 mg.
For example, suppose you are taking 2 mg of Abilify and you want to decrease a 10%. Then, you can mix a crushed pill (2 mg) with some powdered sugar till get 2 g in total. In this case you would take a measurement of 1.8 g of the mixture to accomplish a decrease of 0.2 mg (10%).
This method is really useful when you make proportional dosages. We assume that this dry mixed powder is as good as the liquid suspension. Other proportions and concentrations can be made depending on the doses we need, of course.
Regards

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Interesting and creative, sofre.

 

How do you know the powders are evenly distributed?

 

Please start a topic for yourself in the Introductions forum so we can get to know you.

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Good question Alto. 

It will depend on the mixing time, the particle size, density and shape.

But, the quality of a random mixture improves if the amounts of each component are equivalent.

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Not sure what "quality" means in that sentence. You'd have to give it a good stir to distribute everything evenly, which would be important to accurate dosing.

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Hello,

 

Another update on Abilify. This drug is finally going generic on 4/1/2015. This gives a positive spin on the bad news that the oral solution is being discontinued in May. My question is, how likely is it that the makers of generic aripiprazole put out an oral solution, similar to how risperidone now comes in oral solution? It's hard to tell. I'm going to have to make a tough decision as to whether to stock up on Abilify brand name oral solution by May so that I can taper responsibly, or have faith that eventually a generic Abilify liquid will be made available at a much cheaper cost. It's tough because I highly doubt I'll be able to taper this drug effectively without the liquid solution. I guess we can see what transpires in the 45 days between Abilify going generic and the discontinuation of the liquid on 5/15.

 

My Kaiser pharmacy has said they compound medicines, but the latest person I asked about it said that they do not. It's hard to get a straight answer.

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Most likely there will be a generic, but you might stock up just before the liquid is discontinued so you have time to do some research.

 

Get an answer in writing from Kaiser.

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