Should Abilify (aripiprazole) be taken in the morning (am) or evening (pm)?

Aripiprazole (Abilify) Dosing: Morning vs Evening Administration

Aripiprazole (Abilify) can be administered once daily without regard to meals or time of day, as the FDA label does not specify a preferred time of administration. 1

Pharmacological Properties Relevant to Timing

• Aripiprazole is a unique atypical antipsychotic with partial agonist activity at dopamine D2 and serotonin 5-HT1A receptors, and antagonist activity at 5-HT2A receptors 2
• Unlike sedating antipsychotics, aripiprazole has a more activating profile for many patients
• The medication has a long half-life of approximately 75 hours 3, which means:
  • Steady-state plasma concentrations are achieved after 14 days of treatment
  • Time of day administration is less critical from a pharmacokinetic perspective

FDA Dosing Guidance

The FDA label for aripiprazole clearly states:

• The recommended starting and target dose is 10 or 15 mg/day "administered on a once-a-day schedule without regard to meals" 1
• No specific time of day (morning or evening) is mandated in the official prescribing information
• Dosage adjustments are recommended for CYP2D6 poor metabolizers and patients taking concomitant CYP3A4 inhibitors or inducers, but timing of administration is not specified 1

Clinical Considerations for Timing

When deciding between morning or evening administration, consider:

Morning Administration May Be Preferred If:

• Patient experiences activation or insomnia as a side effect
• Medication adherence is better with morning routines
• Patient is taking other sedating medications in the evening

Evening Administration May Be Preferred If:

• Patient experiences mild sedation as a side effect
• Patient experiences nausea that might be better tolerated at night
• Medication adherence is better with evening routines

Common Side Effects That May Influence Timing

• Most common side effects include headache, anxiety, insomnia, nausea, and lightheadedness 4
• Unlike many other antipsychotics (such as quetiapine or olanzapine), aripiprazole is not typically associated with significant sedation for most patients
• If insomnia occurs, morning dosing may be preferable
• If any sedation occurs, evening dosing may be preferable

Practical Approach

1. Start with morning administration if the patient has a history of medication-induced insomnia or activation
2. Start with evening administration if the patient has a history of mild sedation with medications
3. If side effects emerge, consider switching the time of administration
4. Monitor for effectiveness and side effects, adjusting as needed

Important Caveats

• Unlike medications specifically recommended for evening use due to sedating properties (like mirtazapine or trazodone) 5, aripiprazole does not have a strong recommendation for either morning or evening dosing
• The long half-life of aripiprazole (75 hours) 3 means that the exact timing of the dose is less critical compared to medications with shorter half-lives
• Consistency in timing is more important than the specific time chosen

Remember that the FDA label explicitly states aripiprazole can be administered "without regard to meals" and does not specify a preferred time of day 1, giving flexibility in administration timing based on individual response and preference.