What is the recommended tapering schedule for Abilify (aripiprazole)?

Recommended Tapering Schedule for Abilify (Aripiprazole)

For patients discontinuing aripiprazole, a gradual taper of 10% of the original dose per week is recommended as a reasonable starting point, with adjustments based on individual response and withdrawal symptoms.

General Tapering Principles

• A decrease of 10% of the original dose per week is a reasonable starting point for tapering aripiprazole, though tapering plans should be individualized based on patient response 1
• For patients who have been on aripiprazole for longer durations (e.g., years), slower tapers of 10% per month might be more appropriate and better tolerated 1
• Tapers may need to be paused and restarted when the patient is ready, and might need to be slowed once patients reach lower dosages 1
• A taper should be considered successful as long as the patient is making progress, even if temporary pauses are needed 1

Specific Tapering Protocol for Aripiprazole

• For most patients on standard doses (10-15 mg/day), reduce by approximately 1-1.5 mg per week 2, 3
• Once reaching lower doses (around 2-5 mg), consider slowing the taper further to minimize withdrawal effects 1, 4
• When the smallest available dose is reached, extend the interval between doses (e.g., every other day) before complete discontinuation 1
• Aripiprazole may be stopped when taken less frequently than once a day 1

Managing Withdrawal Symptoms

• Monitor for withdrawal symptoms such as anxiety, insomnia, nausea, dizziness, irritability, and tremor after each dose reduction 1
• If severe withdrawal symptoms occur, return to the previous well-tolerated dose and slow the taper further 1
• Consider adjunctive medications to manage specific withdrawal symptoms:
  • For insomnia: short-term sleep aids may be beneficial 1
  • For anxiety and irritability: short-term use of supportive medications may be considered 1

Special Considerations

• More rapid tapers might be needed for patient safety under certain circumstances (e.g., for patients who have experienced severe adverse events on their current dosage) 1
• Patients switching from aripiprazole to another antipsychotic should have a period of overlapping administration, with the period of overlap minimized 2
• Hyperbolic tapering (making reductions smaller as the dose gets lower) may be more effective than linear tapering for minimizing withdrawal symptoms 4
• Final doses before complete cessation may need to be very small to prevent significant neurochemical changes when stopped 4

Potential Pitfalls to Avoid

• Avoid ultrarapid detoxification, which is associated with substantial risks 1
• Discuss with patients the increased risk for relapse on abrupt return to a previously prescribed higher dose 1
• Do not use a "one-size-fits-all" approach; tapering schedules need to be adjusted based on individual response 1
• Be aware that withdrawal symptoms may be mistaken for relapse of the underlying condition 5, 6