Recommended Dosing for Abilify (Aripiprazole)
The recommended starting and target dose for aripiprazole (Abilify) is 10 or 15 mg once daily, administered without regard to meals. 1
Adult Dosing Guidelines
Schizophrenia
- Starting dose: 10-15 mg once daily
- Effective dose range: 10-30 mg daily
- Maximum dose: 30 mg daily (doses higher than 10-15 mg/day have not shown greater efficacy)
- Titration: Dosage increases should not be made before 2 weeks (time needed to achieve steady-state)
Bipolar Disorder (Manic/Mixed Episodes)
- Starting dose: 10-15 mg once daily
- Effective dose range: 10-30 mg daily
- Titration: Similar to schizophrenia dosing
Adolescent Dosing
Schizophrenia (13-17 years)
- Starting dose: 2 mg daily
- Titration schedule:
- Day 2: Increase to 5 mg
- Day 4: Increase to target dose of 10 mg
- Target dose: 10 mg daily
- Maximum dose: 30 mg daily (not shown to be more effective than 10 mg)
Bipolar I Disorder (≥13 years)
- Recommended dose: 10 mg once daily for 12 weeks
- Maximum dose: Higher doses (30 mg) show less favorable tolerability without increased efficacy 2
Special Populations and Dosage Adjustments
CYP2D6 Poor Metabolizers
- Reduce dose by 50%
Patients Taking CYP3A4 Inhibitors or CYP2D6 Inhibitors
- Reduce aripiprazole dose by 50% when co-administered with strong inhibitors
Patients Taking Strong CYP3A4 Inducers
- Double aripiprazole dose and further adjust based on clinical evaluation
Important Clinical Considerations
Onset of Action
- Full therapeutic effect may take 1-4 weeks to achieve 3
- Some improvement may be observed within the first week of treatment
Administration
- Can be taken with or without food
- Once-daily dosing schedule
Monitoring
- Regular assessment of clinical response
- Monitoring for side effects, particularly:
- Headache
- Anxiety
- Insomnia
- Nausea
- Vomiting
- Lightheadedness
Common Pitfalls and Caveats
Premature dose escalation: Avoid increasing dose before 2 weeks of continuous therapy, as steady-state concentrations require 14 days to achieve 3
Inadequate trial duration: At least 1-2 weeks, sometimes up to 4 weeks, may be needed before aripiprazole reaches full effect 3
Abrupt discontinuation: When switching from other antipsychotics, gradual discontinuation of previous medication is often more appropriate than immediate discontinuation 1
Overlooking drug interactions: Aripiprazole is metabolized by both CYP3A4 and CYP2D6 enzymes, creating potential for significant drug interactions 1
Inappropriate dosing in special populations: Dosage adjustments are required for CYP2D6 poor metabolizers and patients taking CYP enzyme inhibitors or inducers
Aripiprazole's unique pharmacological profile as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, along with antagonism at 5-HT2A receptors, contributes to its efficacy and tolerability profile 4. This mechanism differs from other atypical antipsychotics and may explain some of its clinical advantages.