What is the typical starting dose of Abilify (aripiprazole) for a 16-year-old?

Abilify Dosing for a 16-Year-Old

For a 16-year-old with schizophrenia, start aripiprazole at 2 mg/day, titrate to 5 mg after 2 days, then to the target dose of 10 mg/day after 2 additional days. 1

Indication-Specific Dosing

Schizophrenia (Most Common Indication)

• Starting dose: 2 mg/day 1
• Titration schedule: Increase to 5 mg after 2 days, then to 10 mg after 2 additional days 1
• Target dose: 10 mg/day 1
• Effective range: 10-30 mg/day, though doses above 10 mg/day have not demonstrated superior efficacy 1
• Maximum studied dose: 30 mg/day 1, 2

The FDA label specifically addresses adolescent schizophrenia (ages 13-17 years) with this graduated titration approach, which differs from the adult recommendation of starting directly at 10-15 mg/day 1. This slower titration in adolescents minimizes adverse effects while allowing time to assess tolerability 2.

Bipolar Mania

• Approved dose: 10 mg once daily for 12 weeks in adolescents ≥13 years 2
• The 30 mg/day dose showed no additional efficacy benefit over 10 mg/day and had worse tolerability 2

Autism-Related Irritability (Ages 6-17)

• Starting dose: 2 mg/day 3
• Target range: 5-15 mg/day 3
• Titration: Increase to 5 mg/day after 2 days, with further increases as needed 3

Weight-Based Considerations

• If weight >40 kg: Dose as adults (10-15 mg/day starting dose for most indications) 3
• If weight <40 kg: Use the pediatric titration schedule described above 3

At 16 years old, most patients will weigh >40 kg, but weight should still guide the decision between adult and pediatric dosing approaches 3.

Key Dosing Principles

Steady-State and Time to Effect

• Steady-state: Achieved by day 14 due to the 75-hour elimination half-life 1, 4
• Time to full effect: 1-4 weeks may be required before reaching maximum therapeutic benefit 4
• Minimum interval between dose increases: 2 weeks to allow for steady-state achievement 1

Optimal Dose Range

• Most effective dose: 10 mg/day shows the highest response rate in schizophrenia 5
• Threshold for clinical effect: Between 5-10 mg/day 5
• Doses >20 mg/day: Provide no additional benefit and may be associated with smaller symptom improvement 5

Important Caveats

Tolerability in Adolescents

• Younger patients (10-12 years) show less favorable tolerability than older adolescents (≥13 years) 2
• Lower doses (10 mg/day) are better tolerated than higher doses (30 mg/day) in this age group 2
• Common adverse effects include sedation, weight gain, and extrapyramidal symptoms (EPS), though EPS incidence at 10 mg/day is similar to placebo 2, 6

Dose Adjustments for Drug Interactions

• With strong CYP3A4 or CYP2D6 inhibitors: Reduce dose to 50% of usual dose 1
• With both CYP3A4 and CYP2D6 inhibitors: Reduce to 25% of usual dose 1
• With strong CYP3A4 inducers: Double the usual dose 1
• CYP2D6 poor metabolizers: Reduce dose to 50% of usual dose 1

Administration

• Can be taken without regard to meals 1
• Once-daily dosing is standard 1

Monitoring

• Assess for akathisia, sedation, and weight gain during titration 2
• Periodically reassess need for continued maintenance treatment 1