What is the proper prescribing and dosing protocol for Aripiprazole (Abilify)?

From the Guidelines

Aripiprazole should be prescribed starting at 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. When considering the proper prescribing and dosing protocol for Aripiprazole (Abilify), it's crucial to prioritize the most recent and highest quality study available, which in this case is from 2018 1.

Key Considerations

• The suggested starting dose of Aripiprazole is 5 mg p.o. or i.m. (immediate-release) stat, with a scheduled dosing of q24h if required.
• Dose reduction is necessary in older patients and in poor metabolisers of cytochrome P450 2D6.
• Aripiprazole is less likely to cause extrapyramidal symptoms (EPSEs) compared to other antipsychotics.
• Potential side effects include headache, agitation, anxiety, insomnia, dizziness, and drowsiness.
• Caution is advised due to potential cytochrome P450 2D6 and 3A4 drug–drug interactions, and consultation with a pharmacist or pharmacy references is recommended for further details.

Clinical Application

In clinical practice, Aripiprazole's unique mechanism as a partial dopamine agonist contributes to its favorable side effect profile, particularly regarding extrapyramidal symptoms and prolactin elevation 1. Regular monitoring of metabolic parameters, weight, and movement disorders is recommended during treatment. It's also important to note that Aripiprazole can be used in various patient populations, including adults and children, with appropriate dose adjustments based on age, hepatic impairment, and other factors. However, the provided evidence primarily focuses on its use in adult cancer patients with delirium, highlighting the need for careful consideration of the patient's overall clinical context when prescribing Aripiprazole.

From the FDA Drug Label

2.1 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

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 proper prescribing and dosing protocol for Aripiprazole (Abilify) is as follows:

• Adults: The recommended starting and target dose is 10 or 15 mg/day, administered once daily.
• Adolescents: The recommended target dose is 10 mg/day.
• Dosage adjustments may be necessary for patients who are known CYP2D6 poor metabolizers or those taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers, as outlined in Table 2 2. Key considerations include:
• Dose increases should not be made before 2 weeks, to allow for steady-state to be achieved.
• Maintenance treatment should be periodically reassessed to determine the continued need for treatment.
• Switching from other antipsychotics should be done with caution, and the period of overlapping antipsychotic administration should be minimized.

From the Research

Proper Prescribing and Dosing Protocol for Aripiprazole (Abilify)

• The recommended starting and target dose for aripiprazole is 10 or 15 mg/day administered on a once-a-day schedule without regard to meals 3, 4.
• Aripiprazole has been systematically evaluated and shown to be effective in a dose range of 10 to 30 mg/day 3, 4.
• Dosage increases should not be made before 2 weeks of continuous therapy, the time needed to achieve steady state 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.

Effective Dose Range

• The effective dose range for aripiprazole in schizophrenia is between 10 and 25 mg/day 6.
• Doses less than 10 mg/day did not show significant efficacy on symptoms of schizophrenia, apart from a specific short-term effect on agitation, at very low doses (starting at 1mg) 6.
• Optimization of treatment, at doses above 25 mg/day, cannot be the subject of evidence-based recommendations 6.

Titration and Administration

• At least 1 to 2 weeks, and sometimes up to 4 weeks, may pass before aripiprazole reaches its full effect 4.
• Aripiprazole is rapidly absorbed after oral administration, with a mean time to peak plasma concentration of 3 hours following multiple-dose administration of aripiprazole 10 or 15 mg 3.
• Steady-state plasma drug concentrations are achieved by 14 days, with the drug appearing to accumulate over this period 3.