What is the typical dosing for Aripiprazole (Abilify) in the treatment of psychiatric disorders?

Aripiprazole Dosing

For adults with schizophrenia, start aripiprazole at 10 or 15 mg once daily without titration, as this is both the starting and target dose, with a therapeutic range of 10-30 mg/day—though doses above 15 mg/day provide no additional efficacy. 1

Standard Adult Dosing for Schizophrenia

• Initial dose: 10 or 15 mg once daily 1
• Target dose: 10 or 15 mg/day (no titration required) 1
• Therapeutic range: 10-30 mg/day, though higher doses (20-30 mg) show no superiority over 10-15 mg 1, 2, 3
• Timing: Once daily, without regard to meals 1
• Dose adjustments: Wait at least 2 weeks before increasing dose (time needed to reach steady-state) 1, 4
• Full therapeutic effect: May take 1-4 weeks to manifest 5

The FDA label is explicit that dosage increases should generally not be made before 2 weeks because steady-state concentrations are achieved by day 14, with 4-fold accumulation occurring over this period due to the 75-hour elimination half-life. 1, 3

Adolescent Dosing (Ages 13-17) for Schizophrenia

• Target dose: 10 mg/day 1
• Starting dose: 2 mg/day 1
• Titration schedule: 1
  • Day 1-2: 2 mg/day
  • Day 3-4: 5 mg/day
  • Day 5+: 10 mg/day (target)
• Subsequent increases: 5 mg increments if needed 1
• Maximum studied: 30 mg/day (but showed no additional benefit over 10 mg) 1

Special Populations

• Elderly patients: Use lower starting doses 6
• Hepatic impairment: Use lower starting doses 6
• CYP2D6 poor metabolizers: Administer half of usual dose 1

Dosage Adjustments for Drug Interactions

The following adjustments are critical due to aripiprazole's metabolism via CYP3A4 and CYP2D6: 1

• Strong CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine) OR strong CYP3A4 inhibitors (itraconazole, clarithromycin): Reduce dose to 50% of usual dose 1
• Both strong CYP2D6 AND CYP3A4 inhibitors together: Reduce dose to 25% of usual dose 1
• CYP2D6 poor metabolizers taking strong CYP3A4 inhibitors: Reduce dose to 25% of usual dose 1
• Strong CYP3A4 inducers (carbamazepine, rifampin): Double the usual dose over 1-2 weeks 1
• When discontinuing interacting drugs: Return to original dose (gradually over 1-2 weeks for inducers) 1

Other Psychiatric Indications

Autism Spectrum Disorder (Children/Adolescents)

• Dose range: 5-15 mg/day (flexibly dosed) 7
• Fixed doses studied: 5,10, or 15 mg/day in children ages 6-17 7
• Response rate: 56% at 5 mg vs 35% on placebo 7
• Common side effects: Somnolence, weight gain, drooling, tremor, fatigue, vomiting 7

PTSD-Related Nightmares

• Dose range: 15-30 mg/day 7
• Duration to effect: 4 weeks 7
• Efficacy: Substantial improvement but not complete resolution in 4 of 5 veterans studied 7
• Notable: One patient discontinued due to paradoxical excitement 7

Clozapine Augmentation for Treatment-Resistant Schizophrenia

• Aripiprazole can be used to augment clozapine when significant positive symptoms persist 7
• Specific dosing for augmentation not provided in guidelines 7

Key Clinical Pearls

• No titration needed for adults with schizophrenia—unlike most antipsychotics, you can start at the target dose 1, 4
• The 75-hour half-life means steady-state takes 14 days, so clinical decisions about dose adjustments should wait at least 2 weeks 1, 3
• Doses above 15 mg/day offer no additional efficacy for schizophrenia, only increased side effect burden 1, 2
• Oral solution can substitute for tablets mg-per-mg up to 25 mg; patients on 30 mg tablets should receive 25 mg solution 1