Aripiprazole (Abilify) Oral Titration
For adults with schizophrenia, aripiprazole does not require dose titration—start directly at the target dose of 10-15 mg once daily, as steady-state is achieved in 14 days and dosage increases should generally not be made before 2 weeks. 1
Standard Adult Dosing (Schizophrenia)
- No titration is necessary for aripiprazole in adults—the recommended starting dose is simultaneously the target dose of 10 or 15 mg/day administered once daily without regard to meals 1, 2
- The effective dose range is 10-30 mg/day, though doses higher than 10-15 mg/day have not demonstrated superior efficacy 1, 3
- Wait at least 2 weeks before considering any dose increases, as this is the time required to reach steady-state plasma concentrations 1, 4
- Full therapeutic effect may take 1-4 weeks to manifest due to the drug's long elimination half-life of approximately 75 hours 2, 4
Adolescent Dosing (Ages 13-17, Schizophrenia)
If treating adolescents, a gradual titration is required 1:
- Start at 2 mg daily
- Increase to 5 mg after 2 days
- Increase to target dose of 10 mg after 2 additional days
- Subsequent increases should be in 5 mg increments
- The 30 mg/day dose showed no additional benefit over 10 mg/day 1
Elderly Patients
- In elderly inpatients, lower starting doses are typically used: median starting dose of 5 mg daily with a median maximum dose of 10 mg daily 5
- When titration occurs in elderly patients, the mean time to first dose increase is 3.4 days, with mean time to maximum dose of 5 days 5
- Aripiprazole is generally well tolerated in elderly patients, with agitation/activation being the most common side effect (8%) 5
Key Clinical Considerations
Steady-state pharmacokinetics drive the titration timeline: aripiprazole accumulates over 14 days, with day-14 peak plasma concentrations and AUC values being 4-fold greater than day-1 values 2. This accumulation pattern explains why dose adjustments before 2 weeks are not recommended.
Common pitfall to avoid: Do not increase the dose prematurely due to perceived lack of response in the first 1-2 weeks, as therapeutic effects require time to develop even after steady-state is achieved 4.
Dosage Adjustments for Drug Interactions
When coadministered with CYP450 inhibitors or inducers, dose adjustments are necessary 1:
- With strong CYP3A4 or CYP2D6 inhibitors: Reduce aripiprazole dose
- With strong CYP3A4 inducers: May need to increase aripiprazole dose
- When the interacting drug is discontinued, adjust aripiprazole back to original dose over 1-2 weeks 1
Efficacy by Dose Range
Evidence suggests a dose-response relationship 3:
- 1-10 mg/day: Effective specifically for agitation and hostility symptoms in short-term use
- 10-25 mg/day: Optimal antipsychotic effect for acute and maintenance treatment of schizophrenia
- Above 25 mg/day: No evidence-based support for additional benefit