Starting Abilify (Aripiprazole): Recommended Dosing Schedule

The recommended starting dose for aripiprazole is 10 or 15 mg once daily, administered without regard to meals, with no titration required. 1

Initial Dosing for Schizophrenia

Start at 2 mg once daily 1
Increase to 5 mg after 2 days 1
Increase to target dose of 10 mg after 2 additional days (total 4 days to reach target) 1
Subsequent increases should be in 5 mg increments if needed 1

Steady-state plasma concentrations are achieved by day 14 1, 2
The elimination half-life is approximately 75 hours, leading to 4-fold accumulation by day 14 compared to day 1 2
Clinical effect may take 1-2 weeks, and sometimes up to 4 weeks, to reach full therapeutic benefit 3
Some efficacy is observable as early as the first or second week of treatment 2

The effective dose range is 10 to 30 mg/day, though doses higher than 10-15 mg/day have not demonstrated superior efficacy 1
If dose increases are considered, wait at least 2 weeks before adjusting (the time needed to achieve steady-state) 1
The optimal dose appears to be 10 mg/day, with the highest response rates observed at this dose 4
Doses above 20 mg/day provide no additional benefit and may be associated with smaller symptom improvements 4

Monitor closely for akathisia (restlessness), particularly in the first 4 weeks 5, 6
Akathisia is dose-dependent and increases with higher doses 6, 7
The incidence of EPS with aripiprazole is generally at placebo levels 2

Aripiprazole has a low propensity for clinically significant weight gain compared to other atypical antipsychotics 2
Baseline weight should be documented, with regular monitoring thereafter 2

Most frequent treatment-emergent effects include insomnia, anxiety, headache, and agitation 2
These effects typically have a similar incidence to placebo 2

When starting aripiprazole in patients taking interacting medications, dose modifications are required: 1

With strong CYP2D6 or CYP3A4 inhibitors: Administer half the usual dose 1
With both strong CYP2D6 AND CYP3A4 inhibitors: Administer one-quarter the usual dose 1
In known CYP2D6 poor metabolizers: Administer half the usual dose 1
With strong CYP3A4 inducers (e.g., carbamazepine, rifampin): Double the usual dose over 1-2 weeks 1

Do not titrate the dose in adults—the starting dose of 10-15 mg is the target dose 1
Do not increase doses before 2 weeks of continuous therapy, as steady-state is not achieved until day 14 1, 3
Do not exceed 30 mg/day, as higher doses provide no additional benefit and increase adverse effects 1, 4
Do not expect immediate full therapeutic effect—allow 1-4 weeks for maximal response 3
Do not abruptly discontinue if switching to another antipsychotic, as withdrawal symptoms can occur 5