Can I continue 10mg oral aripiprazole (Abilify) for 1 week instead of 2 weeks due to complaints of oversedation after administering a 400mg intramuscular (IM) injection?

Oral Aripiprazole Duration After IM Injection with Oversedation

No, you should not reduce the oral aripiprazole overlap to 1 week—maintain the full 2-week overlap at a reduced dose (5 mg instead of 10 mg) to address oversedation while ensuring therapeutic aripiprazole levels are maintained. 1

Rationale for 2-Week Overlap

• Aripiprazole requires 14 days to reach steady-state concentrations after initiating the long-acting injectable formulation, which is critical for maintaining therapeutic efficacy 1, 2

• The FDA-approved prescribing information explicitly states that oral aripiprazole supplementation should continue for 14 days after the first IM injection to bridge the gap until therapeutic plasma concentrations are achieved from the depot formulation 1

• Pharmacokinetic data demonstrate that median aripiprazole plasma concentrations reach therapeutic levels within 7 days, but interpatient variability necessitates the full 14-day overlap to ensure all patients maintain adequate coverage 3

Managing Oversedation

The appropriate response to oversedation is dose reduction, not duration reduction:

• Reduce the oral aripiprazole dose from 10 mg to 5 mg daily while maintaining the full 14-day overlap period 1

• The FDA label specifically addresses dose adjustments for tolerability concerns, recommending lower doses in patients experiencing adverse effects rather than shortening the overlap period 1

• Clinical trial data show that patients stabilized on oral aripiprazole 10 mg versus 30 mg both successfully transitioned to the 400 mg IM depot, indicating that lower oral doses during overlap are safe and effective 3

Risk of Premature Discontinuation

• Stopping oral supplementation at 1 week creates a high risk of subtherapeutic aripiprazole levels during weeks 2-4, potentially leading to symptom relapse 3, 4

• A case report documented relapse when depot dosing was inadequate, emphasizing the importance of maintaining therapeutic concentrations during the transition period 4

• Clinical studies showed discontinuation rates due to lack of efficacy ranged from 2.3%-10.0%, and premature cessation of oral overlap would likely increase this risk 3

Common Pitfalls to Avoid

• Do not confuse sedation from the oral aripiprazole with the expected pharmacologic profile—aripiprazole can cause drowsiness and dizziness as documented adverse effects 5

• Avoid the temptation to shorten the overlap period based on subjective improvement—plasma concentrations may not yet be therapeutic even if symptoms appear controlled 3

• Monitor for akathisia and extrapyramidal symptoms, which are more common concerns with aripiprazole than oversedation 6

Practical Management Algorithm

1. Continue oral aripiprazole for the full 14 days post-injection 1
2. Reduce the oral dose to 5 mg daily to address oversedation complaints 1
3. Reassess sedation after 3-5 days at the reduced dose
4. If sedation persists despite dose reduction, consider symptomatic management or evaluate for other contributing factors (drug interactions, concurrent medications) 5
5. Complete the full 14-day overlap before discontinuing oral supplementation 1, 3