Aripiprazole Dosing in Elderly Patients
For elderly patients, aripiprazole should be initiated at a low dose of 5 mg daily and titrated gradually, with a maximum recommended dose of 10-15 mg daily. 1
Initial Dosing and Titration
- Starting dose: 5 mg daily 1
- Titration: Increase gradually based on response and tolerability
- Maximum dose: 10-15 mg daily for most elderly patients 1
- Administration: Can be taken with or without food
Dosing Considerations Based on Condition
For Psychiatric Disorders in Elderly
- For schizophrenia/schizoaffective disorder: Start with 5 mg daily, may increase to 10 mg after 3-4 days if well tolerated 1
- For bipolar disorder: Start with 5 mg daily, may increase to 10-15 mg based on response 2
- For delirium: Lower doses (0.5-5 mg) may be effective 3
Special Considerations for Elderly Patients
Age-Related Physiological Changes
- Decreased hepatic metabolism
- Reduced renal clearance
- Increased sensitivity to medication effects
- Higher risk of side effects, particularly extrapyramidal symptoms
Monitoring Requirements
- Baseline: Complete blood count, metabolic panel, blood pressure, weight
- Follow-up: Monitor for side effects at 1-2 week intervals initially
- Long-term: Regular assessment of metabolic parameters (weight, glucose, lipids)
Common Side Effects in Elderly
- Most common: Agitation/activation (8% of elderly patients) 1
- Other potential effects: Headache, anxiety, insomnia, nausea, lightheadedness 4
- Advantages: Lower risk of extrapyramidal symptoms, minimal weight gain, and no significant effect on prolactin levels compared to other antipsychotics 5
Clinical Pearls and Pitfalls
- Start low, go slow: Elderly patients are more sensitive to both therapeutic and adverse effects of aripiprazole
- Avoid rapid titration: The mean time to first dose increase in studies was 3.4 days 1
- Watch for activation: Unlike other antipsychotics that cause sedation, aripiprazole can cause activation/agitation in elderly patients
- Drug interactions: Use caution when combining with strong CYP3A4 or CYP2D6 inhibitors, which may necessitate dose reduction
- Tolerability: Aripiprazole is generally well-tolerated in elderly populations, with most studies showing a side effect profile similar to placebo 6
Evidence Quality
The recommendations are based on retrospective analyses and open-label trials specifically in elderly populations. The study by Coley et al. (2009) 1 provides the most direct evidence for dosing in elderly psychiatric inpatients, showing that most elderly patients were effectively treated with 10-15 mg/day. This is supported by Sajatovic et al. (2008) 2, which demonstrated efficacy and tolerability of aripiprazole in older adults with bipolar disorder at a mean dose of 10.26 mg/day.