Starting Dose of Aripiprazole for Adults
The recommended starting dose for aripiprazole in adults is 10 or 15 mg once daily, administered without regard to meals. 1
Dosing Guidelines
- The FDA-approved starting and target dose for aripiprazole tablets in adults is 10 or 15 mg/day administered on a once-a-day schedule 1
- Aripiprazole has been systematically evaluated and shown to be effective in a dose range of 10 to 30 mg/day 1, 2
- Higher doses (above 10 or 15 mg/day) have not demonstrated greater efficacy than the standard starting doses 1, 3
- Steady-state plasma concentrations are achieved within 14 days of starting treatment 1, 4
- Dosage increases should generally not be made before 2 weeks, which is the time needed to achieve steady-state 1
Special Populations and Considerations
- For patients who are known CYP2D6 poor metabolizers, dosage adjustments may be required 1
- Patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors may need dose adjustments 1
- In elderly patients, a lower starting dose is often used in clinical practice (median starting dose of 5 mg) 5
- Full therapeutic effect may take 1-2 weeks, and sometimes up to 4 weeks to achieve 4
Clinical Efficacy and Response
- Clinical studies show that aripiprazole is effective as early as the first or second week of treatment 2
- The highest response rate has been observed at 10 mg/day in clinical trials 3
- Doses above 20 mg/day do not appear to provide additional benefit and may be associated with smaller changes in symptom scores 3
Important Monitoring Considerations
- Monitor for common side effects including insomnia, anxiety, headache, and agitation 2
- Aripiprazole has a low propensity to cause clinically significant weight gain, hyperprolactinemia, or QT interval prolongation 2
- The mean elimination half-life of aripiprazole is approximately 75 hours 2, 6
Practical Administration Tips
- Aripiprazole can be administered without regard to meals 1
- When switching from other antipsychotics to aripiprazole, gradual discontinuation of the previous antipsychotic may be most appropriate for some patients 1
- The period of overlapping antipsychotic administration should be minimized when switching medications 1
Remember that while the FDA-approved starting dose is 10-15 mg/day, clinical evidence suggests that 10 mg/day may provide optimal efficacy for most patients, with doses above 20 mg/day offering little additional benefit 3.