What are the recommended dosages for Abilify (aripiprazole)?

Recommended Dosages for Abilify (Aripiprazole)

The recommended starting dose for Abilify (aripiprazole) in adults with schizophrenia is 10-15 mg once daily, with an effective dose range of 10-30 mg daily, though doses higher than 10-15 mg/day have not shown additional benefit. 1

Adult Dosing Guidelines

Schizophrenia

• Starting dose: 10-15 mg once daily
• Effective dose range: 10-30 mg daily
• Maximum dose: 30 mg daily
• Titration: Dosage increases should not be made before 2 weeks (time needed to achieve steady-state)
• Administration: Can be taken without regard to meals 1

Bipolar I Disorder (Manic/Mixed Episodes)

• Starting dose: 15 mg once daily as monotherapy
• Effective dose range: 15-30 mg daily
• Maximum dose: 30 mg daily

Adjunctive Treatment for Major Depressive Disorder

• Starting dose: 2-5 mg once daily
• Effective dose range: 2-15 mg daily
• Maximum dose: 15 mg daily

Pediatric Dosing Guidelines

Schizophrenia (13-17 years)

• Starting dose: 2 mg daily
• Titration: Increase to 5 mg after 2 days, then to target dose of 10 mg after 2 more days
• Target dose: 10 mg daily
• Maximum dose: 30 mg daily (though not shown to be more effective than 10 mg) 1

Bipolar I Disorder (13+ years)

• Recommended dose: 10 mg once daily for 12 weeks
• Starting dose: Lower doses may be used initially with titration to 10 mg 2

Special Population Considerations

CYP2D6 Poor Metabolizers

• Reduce dose by 50% 1

Patients Taking CYP3A4 Inhibitors

• Reduce aripiprazole dose by 50% when co-administered with strong CYP3A4 inhibitors 1

Patients Taking CYP2D6 Inhibitors

• Reduce aripiprazole dose by 50% when co-administered with strong CYP2D6 inhibitors 1

Patients Taking Strong CYP3A4 Inducers

• Double aripiprazole dose and further adjust based on clinical evaluation 1

Combination of Inhibitors

• For patients receiving a combination of strong, moderate, and weak inhibitors of CYP3A4 and CYP2D6, dosing may be reduced to one-quarter (25%) of the usual dose initially and then adjusted to achieve favorable clinical response 1

Clinical Considerations

Efficacy

• Efficacy is typically observed within the first 1-2 weeks of treatment 3
• No additional therapeutic benefit has been demonstrated at doses higher than the recommended range 4
• For maintenance treatment, the effective dose range appears to be 15-28 mg/day 4

Tolerability

• Most common adverse effects include insomnia, anxiety, headache, and akathisia 3
• Generally well-tolerated with placebo-level incidence of extrapyramidal symptoms (EPS) 3
• Low propensity for clinically significant weight gain compared to other atypical antipsychotics 3

Long-Acting Injectable Options

• For patients requiring long-term treatment, long-acting injectable formulations are available:
  • Aripiprazole lauroxil: 1064 mg every 2 months
  • Aripiprazole monohydrate: 960 mg every 2 months 5

Switching from Other Antipsychotics

• No systematic data on specific switching protocols
• Options include:
  1. Immediate discontinuation of previous antipsychotic (suitable for some patients)
  2. Gradual discontinuation (more appropriate for others)
• In all cases, minimize the period of overlapping antipsychotic administration 1

Tapering Recommendations

When discontinuing aripiprazole:

• Gradual tapering is recommended to minimize withdrawal symptoms
• Consider reducing dose by 5-10% every 2-4 weeks
• For patients on higher doses (>15 mg), consider reducing by 5 mg increments
• Monitor for withdrawal symptoms and adjust taper rate as needed 6

Aripiprazole offers a favorable efficacy and safety profile with once-daily dosing and minimal metabolic side effects, making it a valuable option in the treatment of schizophrenia, bipolar disorder, and as adjunctive therapy for major depressive disorder.