What is a Patient Information Leaflet and why is it useful?

The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine. It is possible that the leaflet in your medicine pack may differ from this version because it may have been updated since your medicine was packaged.

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Abilify 7.5 mg/ml solution for injection (intramuscular)

Package leaflet: Information for the user

ABILIFY 7.5 mg/ml solution for injection

aripiprazole

Read all of this leaflet carefully before you receive this medicine because it contains important information for you.

  • Keep this leaflet. You may need to read it again.
  • If you have any further questions, ask your doctor or pharmacist.
  • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
  • If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1. What ABILIFY is and what it is used for
2. What you need to know before you are given ABILIFY
3. How ABILIFY is given
4. Possible side effects
5. How to store ABILIFY
6. Contents of the pack and other information

1. What ABILIFY is and what it is used for

ABILIFY contains the active substance aripiprazole and belongs to a group of medicines called antipsychotics. ABILIFY is used to treat quickly symptoms of agitation and distressing behaviour that may occur in a disease characterised by symptoms such as:

  • hearing, seeing or sensing things which are not there, suspiciousness, mistaken beliefs, incoherent speech and behaviour and emotional flatness. People with this condition may also feel depressed, guilty, anxious or tense.
  • feeling "high", having excessive amounts of energy, needing much less sleep than usual, talking very quickly with racing ideas and sometimes severe irritability.

ABILIFY is given when treatment with oral formulations is not appropriate. Your doctor will change your treatment to oral ABILIFY as soon as appropriate.

2. What you need to know before you are given ABILIFY

Do not use ABILIFY

  • if you are allergic to aripiprazole or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before you are given ABILIFY.

Suicidal thoughts and behaviours have been reported during aripiprazole treatment. Tell your doctor immediately if you are having any thoughts or feelings about hurting yourself.

Before treatment with ABILIFY, tell your doctor if you suffer from

  • high blood sugar (characterised by symptoms such as excessive thirst, passing of large amounts of urine, increase in appetite and feeling weak) or family history of diabetes
  • fits (seizures) since your doctor may want to monitor you more closely
  • involuntary, irregular muscle movements, especially in the face
  • cardiovascular diseases (diseases of the heart and circulation), family history of cardiovascular disease, stroke or "mini" stroke, abnormal blood pressure
  • blood clots, or family history of blood clots, as antipsychotics have been associated with formation of blood clots
  • past experience with excessive gambling

If you notice you are gaining weight, develop unusual movements, experience somnolence that interferes with normal daily activities, any difficulty in swallowing or allergic symptoms, please tell your doctor.

If you are an elderly patient suffering from dementia (loss of memory and other mental abilities), you or your carer/relative should tell your doctor if you have ever had a stroke or "mini" stroke.

Tell the doctor or nurse if you feel dizzy or faint after the injection. You will probably need to lie down until you feel better. The doctor may also want to measure your blood pressure and pulse.

Tell your doctor immediately if you are having any thoughts or feelings about hurting yourself.

Suicidal thoughts and behaviours have been reported during aripiprazole treatment.

Tell your doctor immediately if you suffer from muscle stiffness or inflexibility with high fever, sweating, altered mental status, or very rapid or irregular heartbeat.

Tell your doctor if you or your family/carer notices that you are developing urges or cravings to behave in ways that are unusual for you and you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These are called impulse control disorders and can include behaviours such as addictive gambling, excessive eating or spending, an abnormally high sex drive or preoccupation with an increase in sexual thoughts or feelings.

Your doctor may need to adjust or stop your dose.

Aripiprazole may cause sleepiness, fall in blood pressure when standing up, dizziness and changes in your ability to move and balance, which may lead to falls. Caution should be taken, particularly if you are an elderly patient or have some debility.

Children and adolescents

Do not use this medicine in children and adolescents under 18 years of age. It is not known if it is safe and effective in these patients.

Other medicines and ABILIFY

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Blood pressure-lowering medicines: ABILIFY may increase the effect of medicines used to lower the blood pressure. Be sure to tell your doctor if you take a medicine to keep your blood pressure under control.

Receiving ABILIFY with some medicines may mean the doctor will need to change your dose of ABILIFY or the other medicines. It is especially important to mention the following to your doctor:

  • medicines to correct heart rhythm (such as quinidine, amiodarone, flecainide)
  • antidepressants or herbal remedy used to treat depression and anxiety (such as fluoxetine, paroxetine, venlafaxine, St. John's Wort)
  • antifungal medicines (such as ketoconazole, itraconazole)
  • certain medicines to treat HIV infection (such as efavirenz, nevirapine, an protease inhibitors e.g. indinavir, ritonavir)
  • anticonvulsants used to treat epilepsy (such as carbamazepine, phenytoin, phenobarbital)
  • certain antibiotics used to treat tuberculosis (rifabutin, rifampicin)

These medicines may increase the risk of side effects or reduce the effect of ABILIFY; if you get any unusual symptom taking any of these medicines together with ABILIFY you should see your doctor.

Medicines that increase the level of serotonin are typically used in conditions including depression, generalised anxiety disorder, obsessive-compulsive disorder (OCD) and social phobia as well as migraine and pain:

  • triptans, tramadol and tryptophan used for conditions including depression, generalised anxiety disorder, obsessive compulsive disorder (OCD) and social phobia as well as migraine and pain
  • SSRI s (such as paroxetine and fluoxetine) used for depression, OCD, panic and anxiety
  • other anti-depressants (such as venlafaxine and tryptophan) used in major depression
  • tricyclic’s (such as clomipramine and amitriptyline) used for depressive illness
  • St John’s Wort (Hypericum perforatum) used as a herbal remedy for mild depression
  • pain killers (such as tramadol and pethidine) used for pain relief
  • triptans (such as sumatriptan and zolmitripitan) used for treating migraine

These medicines may increase the risk of side effects; if you get any unusual symptom taking any of these medicines together with ABILIFY, you should see your doctor.

A combination of ABILIFY with medicines taken for anxiety might make you feel drowsy or dizzy.

Only take other medicines while you are on ABILIFY if your doctor tells you that you can.

ABILIFY with food, drink and alcohol

This medicine can be given regardless of meals.

Alcohol should be avoided.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.

The following symptoms may occur in newborn babies, of mothers that have used ABILIFY in the last trimester (last three months of their pregnancy): shaking, muscle stiffness and/or weakness, sleepiness, agitation, breathing problems, and difficulty in feeding. If your baby develops any of these symptoms you may need to contact your doctor.

If you are receiving ABILIFY, your doctor will discuss with you whether you should breast-feed considering the benefit to you of your therapy and the benefit to your baby of breast-feeding. You should not do both. Talk to your doctor about the best way to feed your baby if you are receiving this medicine.

Driving and using machines

Dizziness and vision problems may occur during treatment with this medicine (see section 4). This should be considered in cases where full alertness is required, e.g., when driving a car or handling machines.

3. How ABILIFY is given

Your doctor will decide how much ABILIFY you need and how long you need it for. The recommended dose is 9.75 mg (1.3 ml) for the first injection. Up to three injections in 24 hours may be given. The total dose of ABILIFY (all formulations) should not exceed 30 mg per day.

ABILIFY is ready to use. The correct amount of solution will be injected into your muscle by your doctor or nurse.

If you are given more ABILIFY than you need

This medicine will be given to you under medical supervision; it is therefore unlikely that you will be given too much. If you see more than one doctor, be sure to tell them that you are receiving ABILIFY.

Patients who have been given too much aripiprazole have experienced the following symptoms:

  • rapid heartbeat, agitation/aggressiveness, problems with speech.
  • unusual movements (especially of the face or tongue) and reduced level of consciousness.

Other symptoms may include:

  • acute confusion, seizures (epilepsy), coma, a combination of fever, faster breathing, sweating,
  • muscle stiffness, and drowsiness or sleepiness, slower breathing, choking, high or low blood pressure, abnormal rhythms of the heart.

Contact your doctor or hospital immediately if you experience any of the above.

If you miss an injection of ABILIFY

It is important not to miss your dose. If you miss an injection, you should contact your doctor to arrange your next injection as soon as you can.

If you stop receiving ABILIFY

Do not stop your treatment just because you feel better. It is important that you carry on receiving ABILIFY solution for injection for as long as your doctor has told you to.

If you have any further questions on the use of this medicine, ask your doctor or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Common side effects (may affect up to 1 in 10 people):

  • diabetes mellitus,
  • difficulty sleeping,
  • feeling anxious,
  • feeling restless and unable to keep still, difficulty sitting still,
  • uncontrollable twitching, jerking or writhing movements, restless legs,
  • trembling,
  • headache,
  • tiredness,
  • sleepiness,
  • light-headedness,
  • shaking and blurred vision,
  • decreased number of or difficulty making bowel movements,
  • indigestion,
  • feeling sick,
  • more saliva in mouth than normal,
  • vomiting,
  • feeling tired.

Uncommon side effects (may affect up to 1 in 100 people):

  • increased blood levels of the hormone prolactin,
  • too much sugar in the blood,
  • depression,
  • altered or increased sexual interest,
  • uncontrollable movements of mouth, tongue and limbs (tardive dyskinesia),
  • muscle disorder causing twisting movements (dystonia),
  • double vision,
  • fast heartbeat,
  • increased diastolic blood pressure,
  • a fall in blood pressure on standing up which causes dizziness, light-headedness or fainting,
  • hiccups,
  • dry mouth.

The following side effects have been reported since the marketing of oral aripiprazole but the frequency for them to occur is not known:

  • low levels of white blood cells,
  • low levels of blood platelets,
  • allergic reaction (e.g. swelling in the mouth, tongue, face and throat, itching, hives),
  • onset or worsening of diabetes, ketoacidosis (ketones in the blood and urine) or coma,
  • high blood sugar,
  • not enough sodium in the blood,
  • loss of appetite (anorexia),
  • weight loss,
  • weight gain,
  • thoughts of suicide, suicide attempt and suicide,
  • feeling aggressive,
  • agitation,
  • nervousness,
  • combination of fever, muscle stiffness, faster breathing, sweating, reduced consciousness and sudden changes in blood pressure and heart rate, fainting (neuroleptic malignant syndrome),
  • seizure,
  • serotonin syndrome (a reaction which may cause feelings of great happiness, drowsiness, clumsiness, restlessness, feeling of being drunk, fever, sweating or rigid muscles),
  • speech disorder,
  • fixation of the eyeballs in one position,
  • sudden unexplained death,
  • life-threatening irregular heartbeat,
  • heart attack,
  • slower heartbeat,
  • blood clots in the veins especially in the legs (symptoms include swelling, pain and redness in the leg), which may travel through blood vessels to the lungs causing chest pain and difficulty in breathing (if you notice any of these symptoms, seek medical advice immediately),
  • high blood pressure,
  • fainting,
  • accidental inhalation of food with risk of pneumonia (lung infection),
  • spasm of the muscles around the voice box,
  • inflammation of the pancreas,
  • difficulty swallowing,
  • diarrhoea,
  • abdominal discomfort,
  • stomach discomfort,
  • liver failure,
  • inflammation of the liver,
  • yellowing of the skin and white part of eyes,
  • reports of abnormal liver tests values,
  • skin rash,
  • sensitivity to light,
  • baldness,
  • excessive sweating,
  • abnormal muscle breakdown which can lead to kidney problems,
  • muscle pain,
  • stiffness,
  • involuntary loss of urine (incontinence),
  • difficulty in passing urine,
  • withdrawal symptoms in newborn babies in case of exposure during pregnancy,
  • prolonged and/or painful erection,
  • difficulty controlling core body temperature or overheating,
  • chest pain,
  • swelling of hands, ankles or feet,
  • in blood tests: increased or fluctuating blood sugar, increased glycosylated haemoglobin.
  • Inability to resist the impulse, drive or temptation to perform an action that could be harmful to you or others, which may include:
    • strong impulse to gamble excessively despite serious personal or family consequences
    • altered or increased sexual interest and behaviour of significant concern to you or to others, for example, an increased sexual drive
    • uncontrollable excessive shopping
    • binge eating (eating large amounts of food in a short time period) or compulsive eating (eating more food than normal and more than is needed to satisfy your hunger)
    • a tendency to wander away.
    Tell your doctor if you experience any of these behaviours; he/she will discuss ways of managing or reducing the symptoms.

In elderly patients with dementia, more fatal cases have been reported while taking aripiprazole. In addition, cases of stroke or "mini" stroke have been reported.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store ABILIFY

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and on the vial after EXP.

The expiry date refers to the last day of that month.

Keep the vial in the outer carton in order to protect from light.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What ABILIFY contains

  • The active substance is aripiprazole.
    Each ml contains 7.5 mg aripiprazole.
    A vial contains 9.75 mg (1.3 ml) aripiprazole.
  • The other ingredients are sulfobutylether β-cyclodextrin (SBECD), tartaric acid, sodium hydroxide, and water for injections.

What ABILIFY looks like and contents of the pack

The ABILIFY solution for injection is a clear, colourless, aqueous solution.

Each carton contains one single-use type I glass vial with a rubber butyl stopper and a "tear-off" aluminium seal.

Marketing Authorisation Holder

Otsuka Pharmaceutical Netherlands B.V.
Herikerbergweg 292
1101 CT
Amsterdam
Netherlands

Manufacturer

Zambon S.p.A.
Via della Chimica, 9
I-36100 Vicenza(VI)
Italy

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

United Kingdom
Otsuka Pharmaceuticals (UK) Ltd.
Tel: +44 (0) 203 747 5300

This leaflet was last revised in 04/2019

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site: http://www.ema.europa.eu.