Can I increase the dose of Abilify (aripiprazole) now that the patient was admitted?

Can You Increase Aripiprazole Dose Now That the Patient Was Admitted?

Yes, you can increase the aripiprazole dose now that the patient is admitted, but you must wait at least 2 weeks from the last dose adjustment before making any increase, as this is the time required to reach steady-state concentrations. 1

Timing of Dose Adjustments

• Aripiprazole requires 14 days to reach steady-state plasma concentrations after any dose change, and dosage increases should generally not be made before this 2-week period 1, 2, 3
• The mean elimination half-life is approximately 75 hours for aripiprazole, which explains why steady-state takes 2 weeks to achieve 2, 3
• It may take 1-2 weeks, and sometimes up to 4 weeks, before aripiprazole reaches its full therapeutic effect 3

Recommended Dosing Strategy

• The optimal therapeutic dose is 10-15 mg/day, with the highest response rates observed at 10 mg/day 4
• The FDA-approved dose range is 10-30 mg/day, but doses above 20 mg/day do not appear to provide additional benefit and may be associated with smaller improvements in symptom scores 4
• If the patient is on first-line treatment and positive symptoms persist after 4 weeks at therapeutic dose with good adherence, consider switching to a different antipsychotic rather than increasing aripiprazole beyond 15 mg/day 5

Dose Titration Considerations

• No initial titration is required when starting aripiprazole—the recommended starting dose is already the target dose of 10 or 15 mg/day 1
• Subsequent dose increases should be made in appropriate increments only after the 2-week steady-state period 1
• Dosage adjustments are required if the patient is a CYP2D6 poor metabolizer or taking CYP3A4/CYP2D6 inhibitors or inducers 1

Common Pitfalls to Avoid

• Avoid rapid titration regimens, as these have been associated with adverse cardiovascular effects, particularly in patients with concomitant risk factors 6
• Do not assume that higher doses will provide better efficacy—the dose-response curve for aripiprazole plateaus at 10 mg/day 4
• Remember that aripiprazole can be effective as early as the first or second week of treatment, but full effect may take up to 4 weeks 2, 3

Inpatient Setting Advantages

The inpatient setting provides the opportunity for:

• Close monitoring during dose adjustments
• Assessment of adherence (which is critical before concluding treatment failure) 5
• Evaluation of contributing factors if symptoms persist (substance use, medical illness, medication interactions) 5