What is the equivalent dose of Abilify (aripiprazole) for 5mg of olanzapine?

Aripiprazole Dose Equivalent for 5mg Olanzapine

The equivalent dose of aripiprazole (Abilify) for 5mg olanzapine is approximately 7mg daily, based on established dose equivalence ratios from systematic reviews of antipsychotic dosing.

Dose Equivalence Calculation

• Using the classical mean dose method, 1.4mg aripiprazole equals 1mg olanzapine, which translates to approximately 7mg aripiprazole for 5mg olanzapine 1
• The minimum effective dose method provides a similar ratio, with aripiprazole 10mg equivalent to olanzapine 7.5mg, yielding approximately 6.7mg aripiprazole for 5mg olanzapine 2
• Both methodologies converge on a dose range of 6-7mg aripiprazole as equivalent to 5mg olanzapine 1, 2

Practical Dosing Recommendations

• Start with aripiprazole 5-10mg daily as the closest available tablet strengths, with 10mg being the recommended starting dose for most indications 3
• Aripiprazole 10mg daily is the FDA-approved starting dose for schizophrenia and represents the minimum effective dose in clinical trials 2, 3
• The 10mg dose may provide slightly greater efficacy than a strict mathematical equivalent, which can be advantageous during antipsychotic switching 2

Key Differences in Adverse Effect Profiles

• Aripiprazole carries higher risk of akathisia (number needed to harm = 6), restlessness, and insomnia compared to olanzapine 4, 5
• Olanzapine has substantially higher risk of weight gain (number needed to harm = 3) and metabolic effects compared to aripiprazole 4, 5
• Aripiprazole causes less sedation and cardiovascular effects than olanzapine, with fewer changes in blood pressure and heart rate 5
• Both medications can cause somnolence, headache, nausea, and dizziness, though olanzapine produces more sedation overall 5

Clinical Considerations for Switching

• The switch from olanzapine 5mg to aripiprazole should account for the different receptor profiles: aripiprazole acts as a partial D2 agonist while olanzapine is a full D2 antagonist 3
• Monitor closely for akathisia and restlessness when initiating aripiprazole, as these occur more frequently than with olanzapine 4, 5
• Patients may experience less sedation with aripiprazole, which could manifest as insomnia requiring management 5
• The metabolic benefits of switching to aripiprazole (less weight gain, better lipid profile) typically outweigh the increased akathisia risk for most patients 4