Table 7.
Aripiprazole Dosage and Monitoring Guidance
| Guideline | Dose | Patient monitoring parameters | Specific side effects | Specific drug interactions |
|---|---|---|---|---|
| APA | 2.5–5 mg/d, titrated to a max of 15 mg/d (Berman et al., 2007) | General AAP guidance only | General AAP guidance only | General AAP guidance only |
| BAP | 2.5–10 mg/d (Taylor et al., 2015) | General AAP guidance only | General AAP guidance only | – |
| CANMAT | 2–15 mg/d | – | – | Moderate potential for drug-drug interactions (2D6, 3A4 substrate) |
| CPG-S | – | – | Weight gain, dry mouth, constipation (Fava et al., 2012) | – |
| ICSI | General AAP guidance only | – | Higher rates of akathisia and fatigue compared with placebo (Berman et al., 2007; Marcus et al., 2008) | – |
| MPG | 2–10 mg/d | General AAP guidance, plus caution required in cases of severe hepatic impairment. General monitoring advice applies, but lipids and blood pressure may not be required, and less monitoring of weight compared with other AAPs. | General AAP guidance, plus akathisia and restlessness common, and insomnia may be problematic. Caution required in cases of severe hepatic impairment due to findings of increased LFTs, hepatitis, and jaundice (Mallikaarjun et al., 2008; Datapharm Communications Ltd, 2017; Truven Health Analytics, 2018). Very low risk (in relation to other AAPs) for sedation, weight gain, parkinsonism, anticholinergic effects, hypotension, and prolactin level changes. Low risk of akathisia. Low relative effect on QTc. No reported AEs on sexual function. Cases of hypersexuality have been reported (Chen et al., 2011; Vrignaud et al., 2014). | General AAP guidance/refer to guidelines |
| NICE | – | – | – | – |
| RANZCP | General AAP guidance only | General AAP guidance only | General AAP guidance only | – |
| TMAP | 10 mg/d, titrated by 5 mg/d to 10–20 mg/d | General AAP guidance only | General AAP guidance, plus agitation, constipation, EPS, Insomnia, nausea, somnolence | Carbamazepine, fluoxetine, ketoconazole, paroxetine, quinidine, St John’s wort |
| WFSBP | 2–5 mg/d initially, adjustments of up to 5 mg/d no less than once p/w, maximum 15 mg/d | – | Weight gain, akathisia | – |
Abbreviations: –, not reported by guideline; AAPs, atypical antipsychotics; AEs, adverse effects; APA, American Psychiatric Association; BAP, British Association of Psychopharmacology; CANMAT, Canadian Network for Mood and Anxiety Disorders; CPG-S, Clinical Practice Guidelines in the Spanish NHS; ICSI, Institute for Clinical Systems Improvement; EPS, extrapyramidal side-effects; LFTs, liver function tests; NICE, National Institute for Health and Care Excellence; RANZCP, Royal Australian and New Zealand College of Psychiatrists; MPG, Maudsley Prescribing Guidelines; p/w, per week; QTc, corrected Q-T interval; TMAP, Texas Medication Algorithm Project; WFSBP, World Federation of Societies of Biological Psychiatry.