Aripiprazole: uses, side effects and impulse control

Aripiprazole is an antipsychotic. It treats schizophrenia, easing hallucinations, delusions, suspicious thoughts and confused thinking, and it manages the symptoms of mania in bipolar disorder, meaning the extreme mood swings. It affects the brain chemicals dopamine and serotonin. The NHS says it alleviates symptoms but does not cure the underlying condition.

You may be given standard tablets, orodispersible tablets that dissolve in seconds on the tongue, a liquid measured with a syringe, dropper or cup, or an injection that is typically monthly at a GP surgery or mental health clinic.

The NHS gives typical adult figures for schizophrenia of a starting dose of 10 to 15 mg, usual maintenance of 15 mg and a maximum of 30 mg a day, and for mania a start of 15 mg with the same maximum. Younger people start much lower and build up. Take your dose at about the same time daily, with or without food.

If you miss a dose, take it within a few hours of the usual time; skip it if you only remember the next day. Contact your doctor if you miss two or more doses.

The NHS says common effects affect up to 1 in 10 people. Many ease with time.

• Insomnia, which may improve over time and may respond to a change in dose timing or better sleep routines.

• Anxiety or restlessness, which typically settles in days; tell your doctor if it persists.

• Headache, nausea, vomiting, indigestion and constipation, each with practical self-care advice.

• Sleepiness (avoid driving) and blurred vision, which should be reported.

Aripiprazole may alter impulse control. People have reported compulsive gambling, shopping, overeating or increased sexual drive. If you or someone close to you notices this, tell your doctor, who can adjust treatment. The NHS also says to tell the doctor beforehand if you have ever had problems with gambling.

Call NHS 111 or your doctor for signs of high blood sugar (excessive thirst, frequent urination, tiredness, weight loss), movement problems, uncontrollable mouth or tongue movements, a swollen painful leg or a rapid heartbeat. Call 999 for chest pain, breathing difficulty, seizures, an erection lasting more than 2 hours, high temperature with stiff muscles, or thoughts of harming yourself or others.

Tell the prescriber about heart rhythm problems, high or low blood pressure, movement problems of the tongue, mouth or face, a past episode of neuroleptic malignant syndrome, epilepsy, diabetes, blood clots, stroke, dementia or liver problems.

The NHS lists a long set of medicines. These include heart rhythm medicines such as quinidine, amiodarone and flecainide; benzodiazepines, opioids and sedating antihistamines, which add to drowsiness; antifungals; the antidepressants fluoxetine, paroxetine and venlafaxine; some HIV and tuberculosis medicines; carbamazepine, phenytoin and phenobarbital; and triptans. St John's wort may stop it working as well.

The NHS says there is no strong evidence that use in early pregnancy harms the baby, while use late in pregnancy may cause temporary withdrawal effects in the newborn. Aripiprazole passes into breast milk in small amounts and may reduce milk production.

Alcohol is best avoided because it adds to drowsiness and can worsen symptoms. Regular checks of cholesterol, weight and blood glucose are recommended. Do not stop suddenly. Report suspected side effects to the MHRA Yellow Card scheme.