What is the recommended protocol for tapering off Abilify (aripiprazole)?

Tapering Abilify (Aripiprazole)

The recommended approach for tapering Abilify is to reduce the dose gradually by 10% of the most recent dose every 3-6 months, with smaller reductions as the total dose decreases, to minimize withdrawal symptoms and reduce relapse risk. 1

General Principles of Antipsychotic Tapering

• Abrupt discontinuation of antipsychotics like Abilify can lead to withdrawal symptoms and increased risk of relapse due to dopaminergic hypersensitivity that persists after medication cessation 1
• Gradual tapering over months or years in a hyperbolic manner (reducing by smaller and smaller amounts) is recommended to allow neuroadaptations time to resolve 1
• Only about 8.9% of patients receive proper tapering when discontinuing antidepressants/antipsychotics, highlighting the need for better tapering protocols 2

Recommended Tapering Protocol for Abilify

• Begin with small reductions of approximately 5-10% of the current dose (not the original dose) to minimize withdrawal symptoms 1, 3
• Each new dose should be about 90% of the previous dose, rather than using equal decrements throughout the taper 1
• Allow 3-6 months between dose reductions to give the brain time to adjust to each new dose level 1
• For patients on long-term Abilify therapy, slower tapers of 10% per month or slower are more appropriate than faster tapers 1

Practical Implementation

• For patients on higher doses, consider tapering to 50% of the original dose before implementing the 10% reduction schedule 1
• Final doses before complete cessation may need to be as small as 1/40th of a therapeutic dose to prevent a large decrease in dopamine receptor blockade when stopped completely 1
• Some patients may prefer to taper at 10% or less of their most recent dose each month, which should be accommodated if possible 1
• If withdrawal symptoms become severe during tapering, temporarily return to the previous dose and then resume tapering at a slower rate 1

Managing Withdrawal Symptoms

• Monitor for potential withdrawal symptoms including insomnia, anxiety, irritability, and potential psychotic symptoms 1, 3
• For insomnia during tapering, consider temporary use of alternative sleep aids 3
• For anxiety or irritability during tapering, short-term supportive interventions may be beneficial 3

Important Considerations

• The hyperbolic relationship between antipsychotic doses and D2 receptor blockade means that even small dose reductions at lower doses can cause significant changes in receptor occupancy 1
• If the patient is also taking benzodiazepines, address the benzodiazepine taper first due to the higher risks associated with benzodiazepine withdrawal 4
• Close monitoring and support during the tapering process are critical to success 1, 3
• The target dose may not necessarily be zero; some patients may benefit from continuing at a lower maintenance dose 1

Special Populations

• Limited information is available on tapering Abilify in children and adolescents, and weight-based dosing adjustments may be needed for this population 5
• For elderly patients or those with medical comorbidities, even slower tapering may be warranted 1