Section 03 · Monograph
Aripiprazole
Reviewed Nov 2026FDA label
AbilifyAtypical antipsychotic
- Forms
- Tab: 2, 5, 10, 15, 20, 30mg | ODT: 10, 15mg | Sol: 1mg/mL
- Dose
- Tourette's (age 6-18): under 50kg start 2mg, increase to 5mg after 2 days (target 5mg, max 10mg) | 50kg or more: 2mg, 5mg after 2 days, target 10mg on day 8, up to 20mg; halve dose in CYP2D6 poor metabolizers
- MOA
- D2/5-HT1A partial agonism, 5-HT2A antagonism
Black Box Warning
- Increased mortality in elderly patients with dementia-related psychosis
- Suicidal thoughts and behaviors in children, adolescents and young adults (antidepressant effect)
Indications
- Schizophrenia, bipolar I disorder, adjunctive treatment of major depressive disorderFDA-labeled
- Irritability associated with autistic disorderFDA-labeled
- Tourette's disorder in pediatric patients 6 to 18 yearsFDA-labeled
Mechanism of Action
- Partial agonist at dopamine D2 and serotonin 5-HT1A receptors and antagonist at 5-HT2A receptors, reducing tic severity through dopaminergic modulation
Full Dosing
Adult / usual
- Tourette's, under 50kg: start 2mg/day, increase to 5mg after 2 days (target 5mg); may increase to 10mg if tics are not controlled
- Tourette's, 50kg or more: start 2mg/day, 5mg after 2 days, then target 10mg on day 8; may increase up to 20mg in 5mg increments at least weekly
- Known CYP2D6 poor metabolizers: half the usual dose; additional reductions with strong CYP3A4 plus CYP2D6 inhibitors
- Tablets (2-30mg), orally disintegrating tablets (10, 15mg) and oral solution (1mg/mL) available
Contraindications
- Known hypersensitivity to aripiprazole
Drug Interactions
- Strong CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) and CYP3A4 inhibitors raise levels — reduce dose
- CYP3A4 inducers (carbamazepine) lower levels — consider dose increase
- Additive CNS depression with alcohol and sedatives
Adverse Effects
- Pediatric Tourette's: sedation, somnolence, nausea, headache, nasopharyngitis, fatigue, increased appetite
- Akathisia, extrapyramidal symptoms, tardive dyskinesia
- Weight gain and metabolic changes
- Impulse-control disorders (pathological gambling, compulsive behaviors)
- Orthostatic hypotension, seizures
Monitoring Parameters
- Weight, BMI, glucose and lipids
- Abnormal involuntary movements and akathisia
- Impulse-control behaviors and suicidality
Pregnancy & Lactation
- Neonates exposed in the third trimester may have extrapyramidal or withdrawal symptoms
- Present in milk; breastfeeding generally not recommended