From the FDA Drug Label
Strong CYP2D6 (e.g., quinidine, fluoxetine, paroxetine) or CYP3A4 inhibitors (e.g., itraconazole, clarithromycin) Administer half of usual dose
- The recommended dose of Abilify (aripiprazole) as an adjunct to fluoxetine is half of the usual dose.
- The usual dose of Abilify is 10 or 15 mg/day, so the dose as an adjunct to fluoxetine would be 5 mg/day or 7.5 mg/day 1.
From the Research
The recommended dose of Abilify (aripiprazole) as an adjunct to fluoxetine for the treatment of major depressive disorder is typically 2-15 mg per day, with treatment usually beginning with a lower dose of 2-5 mg daily, which can be gradually increased as needed based on clinical response and tolerability, as supported by the study 2.
Key Considerations
- The medication should be taken once daily, with or without food.
- Patients should be monitored for at least 4 weeks before considering dose adjustments, as it may take several weeks to see the full therapeutic effect.
- Common side effects include akathisia (restlessness), insomnia, fatigue, blurred vision, and weight gain.
- Aripiprazole works as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors, which complements the serotonin reuptake inhibition of fluoxetine to provide enhanced antidepressant effects in patients who have not responded adequately to fluoxetine alone, as noted in the study 2.
Important Factors
- Regular follow-up appointments are important to assess effectiveness and manage any side effects.
- The study 3 highlights the importance of dose adjustment, as a 13-year-old girl experienced persistent hiccups when taking 5 mg of aripiprazole, which resolved when the dose was reduced to 2.5 mg.
- The study 4 demonstrates the efficacy of adjunctive aripiprazole in patients with major depression refractory to adequate therapy with bupropion, with patients showing rapid improvement in depressive symptoms at doses of 2.5-10 mg/day.
- The study 5 provides insight into the dose-effect relationship of aripiprazole in the treatment of schizophrenia, suggesting an effective dose range of 10-25 mg/day, but this may not be directly applicable to the treatment of major depressive disorder.