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Atypical Antipsychotic (Partial D2 Agonist) Pregnancy: Caution — neonatal extrapyramidal and withdrawal symptoms; limited data

Aripiprazole

Brand names: Abilify

Adult dose

Dose: Schizophrenia: 10–15 mg OD. Bipolar mania: 15–30 mg OD. Augmentation of antidepressant (MDD): 2–15 mg OD.
Route: Oral (tablet, orodispersible, solution) or IM (acute)
Frequency: Once daily
Max: 30 mg/day oral; 30 mg/day IM (acute)
Unique partial D2 agonist mechanism — lower risk of extrapyramidal side effects and prolactin elevation vs other antipsychotics. Less sedation. Less metabolic syndrome than olanzapine/quetiapine.

Paediatric dose

Route: Oral
Frequency: OD
Max: Schizophrenia (≥15 years): 10 mg OD → 30 mg OD. Bipolar (≥13 years): 10 mg OD → 30 mg OD
Concentration: 1 mg/mL oral solution mg/ml
Licensed for schizophrenia ≥15 years and bipolar manic episodes ≥13 years. Low starting doses in adolescents — titrate slowly.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

  • Unique D2 partial agonist: acts as agonist when dopamine is low (improves negative symptoms) and antagonist when dopamine is high (reduces positive symptoms)
  • Akathisia: can be mistaken for anxiety or psychomotor agitation — assess carefully; treat with propranolol 20–40 mg BD or mirtazapine
  • Lower metabolic risk vs olanzapine/clozapine: useful in metabolically at-risk patients; still monitor fasting glucose and lipids
  • Available as long-acting injectable (Abilify Maintena 400 mg IM monthly) — useful for adherence issues

Contraindications

  • None absolute (unlike some older antipsychotics)

Side effects

  • Insomnia or somnolence (opposite effects in different patients)
  • Nausea (early)
  • Akathisia (common — may be mistaken for anxiety)
  • Metabolic syndrome (lower risk than olanzapine)
  • Tardive dyskinesia (lower risk vs haloperidol)
  • QT prolongation (minimal)
  • Impulse control disorders (rare)

Interactions

  • CYP3A4/CYP2D6 inducers (rifampicin, carbamazepine) — reduce aripiprazole levels (increase dose)
  • CYP3A4/CYP2D6 inhibitors (ketoconazole, fluoxetine, paroxetine) — increase aripiprazole levels (reduce to half dose)
  • Antihypertensives — additive hypotension

Monitoring

  • Weight, BMI, waist circumference (baseline and 3-monthly)
  • Blood glucose and lipids (baseline and 3-monthly)
  • ECG (QTc)
  • EPS and akathisia assessment

Reference: BNFc; BNF; NICE NG117 Psychosis and Schizophrenia; BAP Antipsychotic Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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