Aripiprazole Dosing in Pediatric Patients
Aripiprazole dosing for pediatric patients should be based on age, indication, and weight. For pediatric patients (13-17 years) with schizophrenia, the recommended starting and target dose is 10 mg/day, with a maximum dose of 30 mg/day if needed. 1
Dosing by Age and Indication
Schizophrenia (13-17 years)
- Initial dose: 10 mg once daily 1
- Effective dose range: 10-30 mg/day 1
- Maximum dose: 30 mg/day (not shown to be more efficacious than 10 mg/day) 1, 2
Bipolar I Disorder (10-17 years)
- Initial dose: 2 mg/day for 2 days 1
- Target dose: 10 mg/day 1
- Maximum dose: 30 mg/day (though higher doses may not provide additional benefit) 2, 3
Irritability Associated with Autism Spectrum Disorder (6-17 years)
- Initial dose: 2 mg/day 4
- Target dose: 5-15 mg/day 4
- Titration: Increase to 5 mg/day after 2 days, with further increases as needed 4
Dosing Considerations
Titration Schedule
- Dosage increases should not be made before 2 weeks of continuous therapy 5
- This allows time to achieve steady state plasma concentrations 5
- Full therapeutic effect may take 1-4 weeks to develop 5
Weight-Based Considerations
- Children weighing more than 40 kg should be dosed as adults 4
- For children <40 kg, weight-based dosing may be more appropriate 4
Special Populations
- CYP2D6 poor metabolizers: Reduce dose by 50% 1
- Concomitant use with CYP3A4 inhibitors: Reduce aripiprazole dose 6
- Concomitant use with CYP3A4 inducers: Increase aripiprazole dose 6
Monitoring and Safety
- Monitor for extrapyramidal symptoms, which occur less frequently than with typical antipsychotics 6
- Monitor for weight gain, though aripiprazole has a lower propensity for significant weight gain compared to other atypical antipsychotics 6
- Monitor for akathisia, insomnia, and somnolence, which are common side effects 1
- No routine laboratory monitoring is required, but baseline metabolic parameters should be assessed 6
Clinical Pearls
- The 10 mg/day dose appears to be the optimal dose for most pediatric patients, with doses above 20 mg/day providing little additional benefit 2, 3
- Aripiprazole can be administered without regard to meals, though administration with meals may improve gastrointestinal tolerability 6
- Steady-state concentrations are attained within 14 days of dosing 5
- The long half-life (approximately 75 hours) allows for once-daily dosing 5, 6
Common Pitfalls to Avoid
- Avoid rapid dose escalation; allow at least 2 weeks between dose increases 5
- Avoid unnecessarily high doses; doses above 20 mg/day may not provide additional benefit and may increase side effects 2, 3
- Do not expect immediate response; full therapeutic effect may take up to 4 weeks 5
- Do not discontinue abruptly; gradual tapering is recommended to minimize discontinuation symptoms 6