What is the management and dosing of Aripiprazole (Abilify)?

From the Guidelines

Aripiprazole should be initiated at a dose of 5 mg p.o. or i.m. (immediate-release) stat, with a scheduled dosing of q24h, and reduced doses should be used in older patients and in poor metabolisers of cytochrome P450 2D6. The management and dosing of Aripiprazole (Abilify) is crucial in minimizing its side effects while maximizing its therapeutic benefits. According to the study published in the Annals of Oncology in 2018 1, the suggested starting dose of Aripiprazole is 5 mg, which can be administered orally or intramuscularly.

Key Considerations

• The dose may need to be reduced in older patients and in poor metabolisers of cytochrome P450 2D6, as stated in the study 1.
• Aripiprazole is less likely to cause extrapyramidal side effects (EPSEs) compared to other antipsychotics, but it may cause headache, agitation, anxiety, insomnia, dizziness, and drowsiness.
• The study also notes that Aripiprazole should be used with caution due to potential cytochrome P450 2D6 and 3A4 drug-drug interactions, and it is recommended to consult a pharmacist or pharmacy references for further details 1.

Monitoring and Administration

• Regular monitoring should include assessment of side effects, such as movement disorders, and adjustment of the dose as needed.
• Aripiprazole can be administered with or without food, and its once-daily dosing improves adherence.
• The orally disintegrating tablet or oral solution may provide a faster onset of action compared to standard tablets, which can be beneficial in certain clinical situations.

Comparison with Other Antipsychotics

• The study provides a comparison of Aripiprazole with other antipsychotics, including first-generation antipsychotics like Haloperidol, second-generation antipsychotics like Olanzapine and Quetiapine, and notes the potential benefits and risks associated with each medication 1.

From the FDA Drug Label

1. 1 Schizophrenia Adults The recommended starting and target dose for aripiprazole tablets is 10 or 15 mg/day administered on a once-a-day schedule without regard to meals Dosage increases should generally not be made before 2 weeks, the time needed to achieve steady-state Maintenance Treatment: Maintenance of efficacy in schizophrenia was demonstrated in a trial involving patients with schizophrenia who had been symptomatically stable on other antipsychotic medications for periods of 3 months or longer Adolescents The recommended target dose of aripiprazole tablets is 10 mg/day.
2. 7 Dosage Adjustments for Cytochrome P450 Considerations Dosage adjustments are recommended in patients who are known CYP2D6 poor metabolizers and in patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers

The management and dosing of Aripiprazole (Abilify) involves:

• Starting dose: 10 or 15 mg/day for adults and 10 mg/day for adolescents
• Dose adjustments: should not be made before 2 weeks, and may be necessary for patients who are known CYP2D6 poor metabolizers or taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers
• Maintenance treatment: patients should be periodically reassessed to determine the continued need for maintenance treatment
• Dosage adjustments for special populations:
  • Known CYP2D6 poor metabolizers: administer half of usual dose
  • Patients taking concomitant strong CYP3A4 inhibitors: administer a quarter of usual dose
  • Patients taking strong CYP2D6 or CYP3A4 inhibitors: administer half of usual dose
  • Patients taking strong CYP3A4 inducers: double usual dose over 1 to 2 weeks 2

From the Research

Management and Dosing of Aripiprazole (Abilify)

• Aripiprazole has been approved for the treatment of schizophrenia and bipolar I disorder, with a recommended dose range of 10-30 mg/day for schizophrenia and 15-30 mg/day for manic or mixed states associated with bipolar I disorder 3.
• The dosing strategy for aripiprazole can be tailored to the individual patient's needs, with options for rapid titration/high-dose or slow titration/low-dose strategies 4.
• In the treatment of a manic episode, aripiprazole may be initiated at 15 mg/day and adjusted as required (down to 5-10 mg/day or up to 30 mg/day) 5.
• When switching to aripiprazole, it is frequently advisable to maintain the therapeutic dose of current medication, add aripiprazole 5,10 or 15 mg/day, and adjust between 10 and 30 mg/day depending on response and tolerability 5.
• Aripiprazole has a mean elimination half-life of about 75 hours, and steady-state concentrations are attained within 14 days of dosing 6.
• At least 1 to 2 weeks, and sometimes up to 4 weeks, may pass before aripiprazole reaches its full effect, and dosage increases should not be made before 2 weeks of continuous therapy 6.
• The efficacy of aripiprazole has been demonstrated in the treatment of schizophrenia and acute bipolar mania, with a recommended starting and target dose of 10 or 15 mg/day administered on a once-a-day schedule without regard to meals 6.

Key Considerations

• Aripiprazole has a unique pharmacological profile, with high affinity for dopamine D2 and D3, serotonin 5-HT1A and 5-HT2A receptors 3, 6.
• The drug has a low propensity for weight gain, a favorable metabolic profile, and no association with hyperprolactinemia 3, 7.
• Common adverse events associated with aripiprazole include insomnia, anxiety, headache, and akathisia, but the drug is generally well tolerated 7, 5.
• Aripiprazole may be used as an adjunct in patients with major depressive disorder and an inadequate response to antidepressant treatment 4.