How do I safely stop taking aripiprazole (Abilify)?

Safely Stopping Aripiprazole (Abilify)

Never stop aripiprazole suddenly without consulting your healthcare provider, as this can cause withdrawal symptoms and increase the risk of relapse. 1

Recommended Tapering Approach

General Tapering Principles

• Aripiprazole should be tapered gradually over months rather than weeks to minimize withdrawal symptoms and reduce relapse risk
• The FDA drug label specifically warns against stopping antipsychotic medications suddenly 1
• Hyperbolic tapering (progressively smaller dose reductions) is recommended based on recent evidence 2

Specific Tapering Schedule

1. Initial Phase: Reduce by 25% of your most recent dose

   • This equates to approximately 5 percentage points of dopamine D2 receptor blockade 2
   • For example: If taking 10mg daily → reduce to 7.5mg daily

2. Subsequent Reductions:

   • Make sequential reductions of 25% of the current dose every 3-6 months
   • Each reduction becomes smaller as the total dose decreases
   • Example progression: 10mg → 7.5mg → 5.6mg → 4.2mg → 3.2mg → etc.

3. Final Phase:

   • Continue tapering to very small doses (as low as 1/40th of therapeutic dose) before complete cessation
   • This prevents a large decrease in D2 blockade when stopped completely 2
   • Consider using liquid formulations or splitting tablets for precise dosing at lower levels

Monitoring During Tapering

Watch for Withdrawal Symptoms

• Monitor for emergence of:
  • New or worsening anxiety or depression
  • Insomnia or sleep disturbances
  • Irritability or agitation
  • Return of original symptoms
  • Unusual physical symptoms (headache, nausea, dizziness)

Follow-up Schedule

• Maintain regular contact with your healthcare provider during the tapering process
• Schedule follow-up appointments at each dose reduction
• Consider more frequent monitoring if symptoms emerge

Special Considerations

For Long-Acting Injectable Aripiprazole

If using long-acting injectable aripiprazole:

• Gradually extend the interval between injections
• For 400mg dose: extend from 4 weeks to 7 weeks before reducing to 300mg 3
• Eventually transition to oral medication at equivalent doses (5mg, 2.5mg, or 1.25mg) 3
• Maintain oral medication for 3-6 months before further reductions to account for residual long-acting injectable elimination 3

For Patients with Higher Relapse Risk

• Consider even slower tapering (10% or less of most recent dose per month)
• Titrate to individual tolerance 2
• Pause tapering if withdrawal symptoms emerge until stabilized

Important Warnings

• Never stop taking aripiprazole suddenly - this can cause withdrawal symptoms and increase relapse risk 1
• If you miss a dose, take it as soon as you remember unless it's almost time for your next dose 1
• If withdrawal symptoms become severe, contact your healthcare provider immediately
• Your provider may temporarily pause the taper or return to a previous dose if symptoms emerge

Adjunctive Strategies During Tapering

• Maintain regular sleep schedule
• Engage in regular physical activity
• Consider stress reduction techniques (meditation, deep breathing)
• Ensure adequate social support during the tapering process
• Monitor and manage any emerging symptoms with your healthcare provider

By following a gradual, hyperbolic tapering approach under medical supervision, you can minimize withdrawal symptoms and reduce the risk of relapse when discontinuing aripiprazole.