Aripiprazole in schizophrenia: Dosing and switching in clinical practice

Abstract

This presentation will review the clinical evidence to date regarding the effective dose of oral aripiprazole and practical switching and administration regimens. Early and convenient dose optimization is a key determinant of treatment outcomes in patients with schizophrenia. Ease of dosing is essential to maintain compliance with antipsychotic agents, and rapid and sustained symptom relief will maximize treatment outcomes. Aripiprazole is the most recently available atypical antipsychotic, pharmacologically distinct from other antipsychotic agents. Clinical studies have demonstrated the rapid onset of symptom relief with a starting dose of aripiprazole 10 mg/day in patients with schizophrenia, and the effective dose range has been established with 10-30 mg/day. When switching to aripiprazole from another antipsychotic, this should be conducted according to good psychopharmacological principles. Clinical evidence with aripiprazole indicates that a favorable approach is to maintain the therapeutic dose of the previous antipsychotic in addition to aripiprazole 10 mg/day for at least two weeks. The previous antipsychotic can then be tapered off slowly. If necessary, benzodiazepines or antihistaminergic agents can be used with aripiprazole to treat potential sleep disturbances or to manage other transient emergent events that are most likely due to rebound effects and/or the differential pharmacological profiles of the previous antipsychotic versus aripiprazole. Concomitant anticholinergics can be used when switching from an antipsychotic with anticholinergic properties to smooth the transition between agents. Appropriate initiation and switching strategies should result in increased treatment successes with aripiprazole for short-term and long-term treatment goals.