What is the starting dose of Abilify (aripiprazole) for treating psychosis?

Starting Dose of Abilify (Aripiprazole) for Psychosis

For adults with psychosis, start aripiprazole at 10 or 15 mg once daily without titration, as this is both the recommended starting and target dose. 1

Adult Dosing

• The FDA-approved starting dose is 10 or 15 mg/day administered once daily without regard to meals. 1
• No initial titration is required—you can begin at the target therapeutic dose immediately. 1
• 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 adjustments are needed, wait at least 2 weeks between increases to allow time to reach steady-state concentrations. 1, 2
• Full therapeutic effect may take 1-2 weeks, and sometimes up to 4 weeks. 2

Adolescent Dosing (Ages 13-17)

• Start at 2 mg/day, titrate to 5 mg after 2 days, then to the target dose of 10 mg/day after 2 additional days. 1
• Subsequent increases should be in 5 mg increments if needed. 1
• The 30 mg/day dose showed no additional benefit over 10 mg/day in adolescent trials. 1

First-Episode Psychosis Considerations

• For first-episode psychosis specifically, international guidelines suggest starting with lower initial target doses: risperidone 2 mg/day or olanzapine 7.5-10 mg/day are cited as examples, though aripiprazole is not specifically mentioned in this context. 3
• The principle of using lower doses in first-episode patients to minimize extrapyramidal side effects should be considered. 3

Dose Adjustments for Drug Interactions

Critical adjustments are required based on CYP450 interactions: 1

• With strong CYP2D6 or CYP3A4 inhibitors: Reduce dose to half the usual dose 1
• With both strong CYP2D6 AND CYP3A4 inhibitors: Reduce to one-quarter of usual dose 1
• 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

Clinical Pearls

• Aripiprazole reaches steady-state in 14 days due to its long elimination half-life of approximately 75 hours. 4, 2
• The drug demonstrates efficacy as early as the first or second week of treatment. 4
• Research supports an effective dose range of 10-25 mg/day for schizophrenia, with doses below 10 mg showing limited efficacy except for acute agitation. 5
• Aripiprazole has a favorable tolerability profile with low propensity for weight gain, extrapyramidal symptoms, and metabolic effects compared to other antipsychotics. 4

Common Pitfall to Avoid

Do not start with unnecessarily low doses (e.g., 2-5 mg) in adults thinking you need to titrate slowly—the FDA label explicitly states 10-15 mg is both the starting AND target dose for adults. 1 The exception is adolescents, who do require gradual titration, and patients with significant drug interactions or who are CYP2D6 poor metabolizers. 1