How to Taper Off Aripiprazole (Abilify)
The most effective way to taper off aripiprazole is to gradually reduce the dose over 2-4 months using a hyperbolic tapering schedule, with dose reductions of approximately 10% per month rather than per week to minimize withdrawal symptoms.
Understanding Aripiprazole Withdrawal
Aripiprazole (Abilify) is an atypical antipsychotic that works as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, and as an antagonist at 5-HT2A receptors 1. When discontinuing this medication, a careful approach is needed to prevent withdrawal symptoms and potential relapse.
Recommended Tapering Protocol
Initial Assessment
- Evaluate current dose and duration of treatment
- Assess risk factors for difficult withdrawal:
- Longer duration of treatment (≥1 year)
- Higher doses
- History of anxiety disorders
- Previous withdrawal symptoms
Tapering Schedule
Slow Taper Rate: Reduce by approximately 10% of the original dose per month rather than per week 2
- For example: If taking 10mg daily, reduce by 1mg per month
- For lower doses (≤5mg), consider even smaller reductions
Hyperbolic Tapering: Make smaller reductions as you reach lower doses 3
- First reductions can be larger (e.g., 15-20% of original dose)
- Middle reductions around 10% of original dose
- Final reductions much smaller (5% or less of original dose)
Extended Timeline: Complete taper over 2-4 months for most patients, longer for those on aripiprazole for ≥1 year 2, 4
Specific Approach Based on Current Research
- Gradual Discontinuation: Evidence shows that tapering aripiprazole over 4-6 weeks with half-dose reductions is more effective than immediate discontinuation 4
- Monitoring Schedule: Follow up at least monthly during the tapering process 2
- Pause When Needed: Be prepared to temporarily pause the taper if withdrawal symptoms become significant 2
Managing Withdrawal Symptoms
Common Withdrawal Symptoms
- Anxiety
- Insomnia
- Irritability
- Nausea
- Dizziness
- Tremor
- Mood changes
Symptom Management
Non-pharmacological approaches:
- Regular exercise
- Sleep hygiene practices
- Stress management techniques
- Cognitive behavioral therapy
Supportive medications (if needed):
- Scheduled acetaminophen (not exceeding 3000mg daily) for pain/discomfort 2
- Consider hydroxyzine for temporary anxiety/agitation
- Trazodone for insomnia if severe
Special Considerations
Warning Signs to Slow or Pause Taper
- Significant increase in original symptoms
- Intolerable withdrawal symptoms
- Suicidal ideation
- Severe anxiety or insomnia
When to Seek Additional Support
- If unable to tolerate even small reductions
- If original symptoms worsen significantly
- If new concerning symptoms develop
Important Cautions
- Never stop aripiprazole abruptly - this increases risk of withdrawal symptoms 4
- Inform all healthcare providers about the tapering process
- Have a clear plan for what to do if symptoms worsen
- Consider offering naloxone if patient is concurrently on opioids or benzodiazepines 2
By following this structured approach to tapering aripiprazole, withdrawal symptoms can be minimized while safely discontinuing the medication. The key is patience with a slow, gradual reduction schedule tailored to your specific situation.