Starting Dose for Aripiprazole in Bipolar Disorder
The recommended starting dose for aripiprazole (Abilify) in adults with bipolar disorder is 15 mg once daily, which can be adjusted based on response and tolerability. 1
Dosing Guidelines
Aripiprazole dosing for bipolar disorder follows a specific pattern:
- Initial dose: 15 mg once daily 1
- Dose range: Can be adjusted between 5-30 mg daily based on clinical response 1, 2
- Dose adjustments:
- Can be decreased to 5-10 mg/day if side effects occur
- Can be increased up to 30 mg/day if needed for symptom control
- Wait at least 2 weeks between dose adjustments to allow for steady-state concentrations 2
Pharmacological Considerations
Aripiprazole has unique properties compared to other atypical antipsychotics:
- Acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors 3
- Has a long half-life of approximately 75 hours 2
- Reaches steady-state concentrations within 14 days 2
- Full therapeutic effect may take 1-4 weeks to develop 2
Special Populations
Dose adjustments may be necessary for certain patient groups:
- Elderly patients: Start with lower doses (5 mg daily) 4
- Hepatic impairment: Consider lower starting doses
- Poor metabolizers of CYP2D6: Reduce dose 5
Monitoring and Side Effect Management
When initiating aripiprazole, monitor for:
- Extrapyramidal symptoms
- Weight changes and metabolic parameters
- Blood pressure changes
- Sedation or activation
Common side effects are usually manageable and often resolve shortly after initiation 1.
Switching Strategies
When transitioning from another medication to aripiprazole:
- Maintain the therapeutic dose of current medication
- Add aripiprazole 5-15 mg/day
- Adjust aripiprazole between 10-30 mg/day based on response
- Only after establishing an effective aripiprazole dose should the prior medication be gradually discontinued 1
Pitfalls and Caveats
- Avoid rapid dose escalation, as side effects may be more pronounced
- Full therapeutic effect may take up to 4 weeks, so avoid premature dose increases 2
- Regular monitoring of metabolic parameters is essential as bipolar patients have higher rates of metabolic syndrome 6
- Aripiprazole may cause initial activation or insomnia in some patients, so timing of administration may need adjustment
By following these guidelines, clinicians can optimize the therapeutic benefits of aripiprazole while minimizing potential adverse effects in adults with bipolar disorder.