What is the starting dose of Abilify (aripiprazole) for an adult patient with schizophrenia, bipolar disorder, or major depressive disorder?

Starting Dose of Abilify (Aripiprazole)

Schizophrenia

For adults with schizophrenia, start aripiprazole at 10 or 15 mg once daily without regard to meals. 1

Adult Dosing Details

• Starting dose: 10 or 15 mg/day as a single daily dose 1
• Target dose: 10 or 15 mg/day (no titration required) 1
• Dose range: 10 to 30 mg/day, though doses higher than 10-15 mg/day have not demonstrated superior efficacy 1
• Timing of dose adjustments: Wait at least 2 weeks before increasing dose, as this is the time needed to reach steady-state concentrations 1, 2
• Full therapeutic effect: May take 1-4 weeks to achieve maximum benefit 2

Adolescent Dosing (Ages 13-17)

• Starting dose: 2 mg/day 1
• Titration schedule: Increase to 5 mg after 2 days, then to target dose of 10 mg after 2 additional days 1
• Target dose: 10 mg/day 1
• Subsequent increases: Use 5 mg increments if needed 1
• Maximum studied dose: 30 mg/day, though this was not more effective than 10 mg/day 1

Bipolar Disorder

While the evidence provided does not include specific FDA-approved starting doses for bipolar disorder, aripiprazole has demonstrated efficacy in treating acute manic episodes associated with Bipolar I Disorder 2. The dosing would typically follow similar principles to schizophrenia treatment, starting at 10-15 mg/day for adults 1.

Major Depressive Disorder (Adjunctive Therapy)

For major depressive disorder as adjunctive therapy to antidepressants, aripiprazole is effective at doses of 2-15 mg/day. 3

• Dose range: 2-15 mg/day when used as augmentation therapy 3
• This represents a lower starting range compared to schizophrenia treatment 3

Critical Dosing Adjustments

CYP450 Metabolizer Status and Drug Interactions

Dose reductions are mandatory in specific populations: 1

• CYP2D6 poor metabolizers: Reduce dose by 50% 1
• Concomitant strong CYP3A4 inhibitors: Reduce aripiprazole dose by 50% 1
• Concomitant strong CYP2D6 inhibitors: Reduce aripiprazole dose by 50% 1
• Concomitant strong CYP3A4 inducers: Double the aripiprazole dose 1
• When inhibitors are discontinued: Return to original dose 1
• When inducers are discontinued: Reduce dose to original level over 1-2 weeks 1

Pharmacokinetic Considerations

Why No Titration is Needed for Adults with Schizophrenia

• Aripiprazole has a long elimination half-life of approximately 75 hours 4, 2
• The active metabolite (dehydro-aripiprazole) has an even longer half-life of 94 hours 2
• Steady-state is achieved by day 14, with 4-fold accumulation from day 1 to day 14 4
• This pharmacokinetic profile allows for once-daily dosing without initial titration in most adult patients 1

Switching from Other Antipsychotics

When switching from other antipsychotics to aripiprazole, minimize the period of overlapping administration. 1

• Immediate discontinuation of the previous antipsychotic may be acceptable for some patients 1
• Gradual discontinuation of the previous agent may be more appropriate for others 1
• No systematic data exists to guide specific switching protocols 1

Common Pitfalls to Avoid

• Do not increase dose before 2 weeks: Steady-state requires 14 days, and premature dose escalation increases side effect risk without additional benefit 1, 2
• Do not exceed 15 mg/day without clear rationale: Doses above 10-15 mg/day have not shown superior efficacy in clinical trials 1
• Do not forget CYP450 adjustments: Failure to reduce dose in poor metabolizers or with interacting medications significantly increases adverse event risk 1
• Do not expect immediate response: Full therapeutic effect may take 1-4 weeks despite starting at target dose 2