What is the recommended use and dosage of Abilify (aripiprazole)?

Aripiprazole (Abilify): Recommended Use and Dosing

For schizophrenia, the recommended starting and target dose of Abilify (aripiprazole) is 10-15 mg once daily, with a maximum effective dose of 30 mg daily. 1

Indications and Approved Uses

Aripiprazole is FDA-approved for:

• Schizophrenia

  • Adults: 10-15 mg once daily (effective dose range 10-30 mg/day)
  • Adolescents (13-17 years): 10 mg once daily (starting at 2 mg, titrated to 10 mg over 4 days)

• Bipolar I Disorder

  • Manic or mixed episodes: 15-30 mg once daily

• Major Depressive Disorder

  • As adjunctive therapy to antidepressants: 2-15 mg once daily

• Irritability associated with autism

Dosing Guidelines

For Schizophrenia:

• Initial dose: 10-15 mg once daily
• Maintenance dose: 10-15 mg once daily
• Maximum dose: 30 mg daily (higher doses not shown to be more effective) 1
• Titration: Dosage increases should not be made before 2 weeks (time needed to achieve steady-state) 1

For Adolescents with Schizophrenia (13-17 years):

• Starting dose: 2 mg daily
• Titration: Increase to 5 mg after 2 days, then to target dose of 10 mg after 2 more days
• Target dose: 10 mg daily
• Maximum dose: 30 mg daily (not shown to be more effective than 10 mg) 1

Administration

• Can be taken with or without food 1
• Available as tablets and oral solution (can substitute on mg-per-mg basis up to 25 mg) 1

Special Populations and Dosage Adjustments

CYP2D6 Poor Metabolizers:

• Administer half of usual dose 1

Concomitant Medications:

• With strong CYP2D6 or CYP3A4 inhibitors: Reduce to half of usual dose
• With strong CYP3A4 inducers: Double usual dose over 1-2 weeks
• With both strong CYP2D6 and CYP3A4 inhibitors: Reduce to quarter of usual dose 1

Pharmacological Profile

Aripiprazole has a unique mechanism of action:

• Partial agonist at dopamine D2 and D3 receptors
• Partial agonist at serotonin 5-HT1A receptors
• Antagonist at 5-HT2A receptors 2, 3

Efficacy and Tolerability

• Efficacy: Demonstrated in multiple randomized controlled trials for schizophrenia, with effectiveness apparent within the first 1-2 weeks of treatment 3
• Maintenance: Efficacy maintained for up to 52 weeks in long-term studies 3

Tolerability Advantages:

• Low propensity for weight gain
• Favorable metabolic profile
• No association with hyperprolactinemia
• Minimal QT interval prolongation 2, 3

Common Side Effects:

• Insomnia and anxiety
• Headache and agitation
• Akathisia (may be more common than in schizophrenia when used for depression) 2, 4

Clinical Pearls

1. Starting Treatment: Begin with recommended starting dose based on indication; no need for complex titration in most patients

2. Monitoring: Watch for akathisia and GI complaints, which may emerge at the start of treatment but are often time-limited

3. Switching: When switching from another antipsychotic, gradual discontinuation of the previous medication is recommended while starting aripiprazole 1

4. Long-term Use: Periodically reassess the need for maintenance treatment 1

5. Avoid in Pregnancy: Some antipsychotics have known teratogenic effects; benefit-risk assessment should be conducted before use in pregnancy

Aripiprazole's unique pharmacological profile makes it a valuable option for patients who may be sensitive to the metabolic or extrapyramidal side effects associated with other antipsychotic medications.