What is the recommended dosing pattern for Abilify (aripiprazole)?

Abilify (Aripiprazole) Dosing Pattern

For schizophrenia in adults, start aripiprazole at 10 or 15 mg once daily without titration, as this is the FDA-approved target dose that can be initiated from day one. 1

Adult Schizophrenia Dosing

• Initial dose: 10 or 15 mg once daily, administered without regard to meals 1
• No titration required - the target therapeutic dose can be started immediately on day one with low risk of extrapyramidal symptoms 1, 2
• Dose range: 10-30 mg/day is the FDA-approved effective range, though doses higher than 10-15 mg/day have not demonstrated superior efficacy 1, 2
• Timing of dose adjustments: If increases are needed, wait at least 2 weeks between adjustments to allow time to reach steady-state concentrations 1, 3

Adolescent Schizophrenia Dosing (Ages 13-17)

• Target dose: 10 mg/day 1
• Titration schedule required for adolescents:
  • Start at 2 mg daily
  • Increase to 5 mg after 2 days
  • Increase to target 10 mg after 2 additional days
  • Subsequent increases in 5 mg increments if needed 1
• The 30 mg/day dose showed no additional benefit over 10 mg/day in adolescents 1

Pharmacokinetic Considerations

• Time to steady-state: 14 days - the drug accumulates significantly, with 4-fold higher plasma concentrations on day 14 compared to day 1 2, 3
• Elimination half-life: approximately 75 hours for aripiprazole and 94 hours for the active metabolite dehydro-aripiprazole 2, 3
• Full therapeutic effect: 1-4 weeks may be required before maximum benefit is observed 3

Dose Adjustments for Drug Interactions

When CYP2D6 or CYP3A4 inhibitors are co-administered, dose reduction is required 1:

• Reduce aripiprazole dose by 50% with strong CYP2D6 or CYP3A4 inhibitors
• When both types of inhibitors are present, reduce dose to 25% of usual dose

When CYP3A4 inducers are co-administered, double the aripiprazole dose 1:

• Gradually reduce back to original dose over 1-2 weeks after the inducer is discontinued

Optimal Dosing Based on Evidence

• For acute symptoms: 10-15 mg/day is the evidence-based starting point, with literature suggesting an optimal range of 10-25 mg/day for antipsychotic efficacy 4
• For agitation: Lower doses (1-15 mg) may be effective for acute agitation symptoms specifically 4
• Doses below 10 mg/day lack evidence for efficacy on core schizophrenia symptoms (except for agitation) 4
• Doses above 25 mg/day cannot be recommended based on available evidence 4

Administration Timing

• Once-daily dosing is the standard regimen 1, 2
• Can be taken at any time of day, without regard to meals 1