Starting Dose of Aripiprazole for Adults with Schizophrenia

The recommended starting dose of aripiprazole for adults with schizophrenia is 10 or 15 mg once daily. 1

Dosing Guidelines

The FDA-approved starting and target dose for aripiprazole is 10 or 15 mg/day administered on a once-a-day schedule without regard to meals 1
Aripiprazole has been systematically evaluated and shown to be effective in a dose range of 10 to 30 mg/day, however, doses higher than 10 or 15 mg/day were not more effective than 10 or 15 mg/day 1, 2
Dosage increases should generally not be made before 2 weeks, which is the time needed to achieve steady-state plasma concentrations 1, 3
No dosage titration is necessary when initiating treatment with the recommended starting dose 2

Aripiprazole is a third-generation antipsychotic with a unique mechanism of action as a partial agonist at dopamine D2 receptors 2
The drug reaches steady-state concentrations within 14 days of dosing 3
The mean elimination half-life is approximately 75 hours for aripiprazole 2, 4
Full therapeutic effect may take 1-2 weeks, and sometimes up to 4 weeks to achieve 3

Lower starting doses should be considered in:
- Older patients 5
- Patients with hepatic impairment 5
- Known CYP2D6 poor metabolizers 1
- Patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors 1
Dosage adjustments are necessary when aripiprazole is co-administered with:
- CYP3A4 inhibitors (increased aripiprazole concentration)
- CYP2D6 inhibitors (increased aripiprazole concentration)
- CYP3A4 inducers (decreased aripiprazole concentration) 2

Aripiprazole shows significant efficacy in reducing positive and negative symptoms of schizophrenia at the recommended starting doses 2
The most common adverse effects include headache, anxiety, insomnia, nausea, vomiting, and lightheadedness 4
Aripiprazole has a favorable side effect profile with:
- Low propensity for extrapyramidal symptoms (EPS) 2
- Low risk of clinically significant weight gain 2
- Low risk of hyperprolactinemia 2
- Low risk of QTc interval prolongation 2

Avoid starting at doses below 10 mg/day for treating schizophrenia symptoms (except for specific short-term effects on agitation), as these lower doses have not shown significant efficacy for core schizophrenia symptoms 6
Avoid rapid dose escalation before the 2-week period needed to reach steady-state concentrations 1
Be aware that while higher doses (20-30 mg/day) are within the approved range, they do not provide additional therapeutic benefit over the recommended 10-15 mg starting dose 1, 6
Monitor for drug interactions, particularly with medications that affect CYP3A4 and CYP2D6 enzyme systems 2
When switching from other antipsychotics to aripiprazole, consider a gradual discontinuation of the previous antipsychotic while minimizing the period of overlapping administration 1

For maintenance treatment, the same dose range (10-15 mg/day) that was effective in the acute phase is generally recommended 1
Patients should be periodically reassessed to determine the continued need for maintenance treatment 1
Aripiprazole has demonstrated efficacy in preventing relapse in stable schizophrenia patients at a dose of 15 mg/day 7