Abilify (aripiprazole) vs. Invega (paliperidone): Side Effects & Dosage

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Abilify vs. Invega

• Abilify (aripiprazole) and Invega (paliperidone) are antipsychotic drugs used to treat schizophrenia.
• A difference is that Abilify is also used to treat mania, depression, bipolar disorders, autistic disorders, and some irritable behavior disorders.
• Common side effects of Abilify and Invega include:
  • drowsiness
  • dizziness
  • headache
  • lightheadedness
  • upset stomach
  • nausea
  • weight gain
  • blurred vision
  • decreased sex drive/difficulty having an orgasm
• Serious side effects of Abilify and Invega include:
  • difficulty swallowing or choking
  • shaking (tremors)
  • muscle spasms
  • restlessness
  • fever
  • confusion
  • rapid heartbeats or heart racing
  • mental/mood changes (such as increased anxiety, depression, suicidal thoughts)
• Both Abilify and Invega may interact with other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety), medications to treat high blood pressure or a heart condition, carbamazepine.
• Abilify may also interact with:
  • phenobarbital,
  • phenytoin,
  • rifabutin,
  • rifampin,
  • ketoconazole,
  • itraconazole,
  • quinidine,
  • fluoxetine,
  • fluvoxamine, or
  • paroxetine.
• Invega may also interact with:
  • arsenic trioxide,
  • droperidol,
  • anti-anxiety medications,
  • antibiotics,
  • antidepressants,
  • anti-malaria medications,
  • anti-seizure medications,
  • medicine to prevent or treat nausea and vomiting,
  • medicines to treat Parkinson's Disease,
  • medicines to treat psychiatric disorders, and
  • migraine headache medicines.

What is Abilify? What is Invega?

• Abilify (aripiprazole) is a psychotropic drug (antipsychotic) that alters brain chemical activity used to treat
  • schizophrenia,
  • mania,
  • depression,
  • bipolar disorders,
  • autistic disorder, and
  • some irritable behavior disorders.
• Invega (paliperidone) is an antipsychotic medication used to treat
  • schizophrenia and
  • schizoaffective disorder.

Abilify and Invega warnings, side effects, and patient safety information

Abilify

WARNINGS

Long-term use of aripiprazole may lead to a potentially irreversible condition called tardive dyskinesia (involuntary movements of the jaw, lips, and tongue).

A potentially fatal complex referred to as neuroleptic malignant syndrome has been reported with anti-psychotic drugs, including Abilify. Patients who develop this syndrome may have:

• High fevers
• Muscle rigidity
• Altered mental status
• Irregular pulse or blood pressure
• Rapid heart rate
• Excessive sweating
• Heart arrhythmias

All atypical antipsychotic drugs have been associated with metabolic changes such as hyperglycemia, diabetes mellitus, dyslipidemia, and weight gain. Serious cases of hyperglycemia leading to coma or death have been reported in patients treated with atypical antipsychotics. Although there is no clear link between aripiprazole and diabetes, patients should be tested during treatment for elevated blood-sugars. Additionally, patients with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during medical treatment should be tested for diabetes.

Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death and Abilify should not be used for this indication. Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of this medicine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on medical therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Some of the most common side effects include:

• Anxiety
• Blurred vision
• Constipation
• Cough
• Headache
• Insomnia
• Lightheadedness
• Nausea
• Rash
• Restlessness
• Runny nose
• Sleepiness
• Tremors
• Vomiting
• Weakness
• Weight gain

Invega

The most common side effects include

• drowsiness,
• weight gain,
• headache,
• upper respiratory tract infection,
• increased heart rate,
• constipation,
• feeling restlessness or difficulty sitting still,
• stiffness, and shuffling walk,
• tremors, and
• slow movements.

Less common but serious side effects include:

• Increased risk of stroke and death in elderly patients with dementia-related psychosis.
• Neuroleptic malignant syndrome (NMS): NMS is a rare but serious side effects associated with the use of antipsychotics. NMS may result in death and must be treated in the hospital. Signs and symptoms of NMS may include
• high fever,
• sweating (diaphoresis),
• severe muscle stiffness or rigidity,
• confusion,
• loss of consciousness,
• high blood pressure,
• rapid heartbeat, and
• changes in breathing.
• Extrapyramidal side effects (EPS) including:
  • Dystonia: painful spasms of the oral, throat, or neck muscles that may cause problems with speech, swallowing, and stiff neck.
  • Akathisia: feelings of restlessness or difficulty sitting still.
• Pseudoparkinsonism: drug induced Parkinson's symptoms.
• Tardive dyskinesia (TD): Tardive dyskinesia usually occurs after long-term use of antipsychotics and usually presents with movement problems affecting the tongue, lips, jaw, face, and extremities.
• Metabolic changes including high blood sugar (hyperglycemia), diabetes mellitus, increase in blood cholesterol, and weight gain.
• High blood levels of prolactin. Prolactin is a hormone that allows the production of breast milk. High levels of prolactin may cause menstrual abnormalities, leakage of milk from the breast, development of breast in males (gynecomastia), and erection problems in men.
• Seizures

What are the drugs that interact with Abilify and Invega?

Abilify

• Carbamazepine (Tegretol) can markedly decrease the amount of Abilify in the body by increasing the rate at which the body's enzymes (particularly the liver enzyme, CYP3A4) degrade it. The manufacturer recommends that patients on this drug who are started on carbamazepine double their dose of Abilify, under their doctor's supervision. Other drugs that can promote the activity of CYP3A4 and decrease the body's levels of Abilify are phenytoin (Dilantin), rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate), and phenobarbital.
• Ketoconazole (Nizoral) can increase the amount of aripiprazole in the body by blocking CYP3A4. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during ketoconazole therapy. Many other drugs also are known to block CYP3A4 and potentially could increase the levels of aripiprazole, but their actual effects on aripiprazole levels have not been studied. Such drugs include:
  • itraconazole (Sporanox)
  • fluconazole (Diflucan)
  • voriconazole (Vfend)
  • cimetidine (Tagamet)
  • verapamil (Calan, Isoptin)
  • diltiazem (Cardizem, Dilacor)
  • erythromycin clarithromycin (Biaxin)
  • nefazodone (Serzone)
  • ritonavir (Norvir)
  • saquinavir (Invirase)
  • nelfinavir (Viracept)
  • indinavir (Crixivan)
  • Grapefruit juice
• Quinidine (Quinaglute, Quinidex) inhibits another liver enzyme known as CYP2D6 that also breaks down aripiprazole and can increase the amount of aripiprazole in the body. The manufacturer of aripiprazole recommends reducing the dose of aripiprazole by one-half during quinidine therapy. Other medicines that block CYP2D6 include fluoxetine (Prozac) and paroxetine (Paxil).
• Alpha-1 receptor blockers [doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin)], used for control of blood pressure and prostatic enlargement, may increase the chance of hypotension (unusually low blood pressure).

Invega

• Paliperidone can cause low blood pressure especially when standing up from a sitting or lying position (orthostatic hypotension). Therefore, paliperidone should be used cautiously with other drugs also associated with orthostatic hypotension.
• Paliperidone is metabolized (eliminated) by liver enzymes. Drugs that increase the activity of these enzymes will decrease blood levels of paliperidone thereby decreasing its effect. Paliperidone should not be taken with carbamazepine (Tegretol), phenytoin (Dilantin), rifampin (Rifadin), St. John's Wort, and other drugs that may decrease its blood levels.
• Paliperidone blocks the effect of dopamine in the brain while dopamine agonists such as levodopa (Sinemet) increase the levels of dopamine in the brain. Combining these agents is not recommended since the effect of both drugs will be reduced.
• Divalproex sodium increases blood levels of paliperidone by 50%. The dose of paliperidone should be adjusted based on clinical judgment.

What is the dosage for Abilify vs. Invega?

Abilify

• This dose for this medication usually is once a day.
• The usual adult starting oral dose for patients with schizophrenia or bipolar disorder is 10 to 15 mg once daily. The dose may be increased over time up to 30 mg daily to achieve the desired effect.
• The recommended dose for patients with Tourette's disorder is 5 to 20 mg once daily.

Invega

• Paliperidone is administered once daily by mouth.
• Tablets should be swallowed whole and should not be crushed, divided, or chewed.
• The starting dose for schizophrenia or schizoaffective disorder in adults is 6 mg daily.
• The maintenance dose range is 3 to 12 mg daily.
• The maximum dose is 12 mg daily.
• The dose for treating schizophrenia in adolescents weighing less than 51 kg is 3 to 6 mg daily.
• The dose for adolescents weighing more than 51 kg is 3 to 12 mg daily.

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Are Abilify and Invega Safe to Take During Pregnancy?

Abilify

Aripiprazole has not been adequately studied during pregnancy. Neonates exposed to antipsychotic drugs in the third trimester may experience withdrawal symptoms and other side effects. Your doctor or other healthcare provider may choose to use this medication if he or she feels that its benefits outweigh this potential concern.

It is not known if this medicine is excreted in breast milk; however, since most medicines are excreted in breast milk, doctors and other health care professionals recommend that women should not breastfeed their infant/baby while taking this drug.

Invega

Unborn babies exposed to antipsychotics during the third trimester of pregnancy are at risk for extrapyramidal and withdrawal symptoms after birth. Symptoms reported included agitation, hypertonia, hypotonia, tremor, somnolence, depressed breathing, and feeding disorder. Currently there is no data on the use of paliperidone during pregnancy.

Paliperidone should only be used during pregnancy if the potential benefit to the mother outweighs the potential for side effects in the fetus.
A pregnancy exposure registry has been established to monitor the use of atypical antipsychotics, including paliperidone, during pregnancy.

All pregnant women treated with atypical antipsychotics are advised to enroll in this pregnancy registry and report any side effects.

Paliperidone is known to enter human milk but its effects on the breastfeeding infant or milk production is not yet known.