What is the typical dosing for Abilify (aripiprazole) in adults with schizophrenia or bipolar disorder?

Aripiprazole Dosing for Schizophrenia and Bipolar Disorder

For adults with schizophrenia, start aripiprazole at 10-15 mg once daily without titration, as this is both the starting and target dose, with no additional benefit demonstrated at higher doses. 1

Schizophrenia Dosing

Standard Adult Dosing

• Starting dose: 10 or 15 mg once daily 1
• Target dose: 10 or 15 mg once daily 1
• Effective dose range: 10-30 mg/day, though doses above 10-15 mg/day have not shown superior efficacy 1, 2
• No titration required - aripiprazole can be started at the target therapeutic dose 1, 2
• Administer without regard to meals 1

Timing Considerations

• Wait at least 2 weeks before increasing dose, as this is the time needed to reach steady-state concentrations 1, 3
• Full therapeutic effect may take 1-4 weeks to manifest 3
• Steady-state plasma concentrations are achieved by day 14, with the elimination half-life of approximately 75 hours 2, 3

Adolescent Dosing (13-17 years)

• Target dose: 10 mg/day 1
• Start at 2 mg/day, titrate to 5 mg after 2 days, then to 10 mg after 2 additional days 1
• Subsequent increases in 5 mg increments if needed 1
• The 30 mg/day dose showed no additional efficacy over 10 mg/day 1

Special Populations

Older Adults and Hepatic Impairment

• Use lower starting doses in older or frail patients 4, 5
• Reduce dose gradually in patients with hepatic impairment 4
• For delirium management in cancer patients, start at 5 mg PO or IM once daily 4

CYP450 Drug Interactions

Dosage adjustments are mandatory when aripiprazole is combined with certain medications 1:

• With strong CYP3A4 or CYP2D6 inhibitors: Reduce aripiprazole dose by 50% 1
• With strong CYP3A4 inducers: Double the aripiprazole dose 1
• CYP2D6 poor metabolizers: Reduce dose by 50% 4, 1
• When the interacting drug is discontinued, return to original aripiprazole dose over 1-2 weeks 1

Dose-Response Relationship

Evidence for Optimal Dosing

• 10-25 mg/day appears optimal for maintenance treatment of schizophrenia 6
• Doses below 10 mg/day lack efficacy for core schizophrenia symptoms (though 1-15 mg may help acute agitation) 6
• No evidence supports doses above 25-30 mg/day 6
• Short-term studies show effective range of 10-20 mg/day 6
• Long-term studies (16-52 weeks) show effective average doses of 15-28.1 mg/day 6

Bipolar Disorder Considerations

While the FDA label primarily addresses schizophrenia dosing, aripiprazole is also indicated for bipolar I disorder 3. The same dosing principles apply, with 10-15 mg/day as the starting and target dose 3.

Key Clinical Pitfalls

• Avoid premature dose escalation - wait the full 2 weeks for steady-state before increasing 1, 3
• Do not exceed 30 mg/day - higher doses provide no additional benefit and increase side effects 1, 2
• Screen for CYP450 interactions before prescribing, as dose adjustments are required with many common medications 1
• Monitor for akathisia, the most common movement-related side effect, particularly in the first weeks of treatment 4, 2