Aripiprazole

SGA / Partial Agonist·Psychiatry - Antipsychotics

Schizophrenia, Bipolar I disorder

Authority requiredPBSSGAAbilify, Abilify Maintena (LAI)2 mg tablet+2

Max Dose

30 mg/day

Half-life

75 h

Akathisia

HIGH RISK

Metabolic

LOW RISK

Rapid Summary

Overview

Unique 'third-generation' antipsychotic. Acts as a partial D2 agonist. Highly activating, weight-neutral, but notorious for causing severe akathisia.

Maximum Dose

Max 30 mg/day.

Clinical Focus

Very long half-life (75 hours). Takes up to 2 weeks to reach steady state. Do not up-titrate too quickly.

Bottom Line

Aripiprazole is a unique partial dopamine agonist antipsychotic with the lowest metabolic risk in its class, but can cause paradoxical akathisia and activation early in treatment.

Formulation & Access

Brand Names

Abilify, Abilify Maintena (LAI)

Oral Routes

Tablets (2 mg to 30 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia, Bipolar I disorder.

Off-Label

OFF

Treatment-resistant major depressive disorder (adjunct).

Clinical Place

Preferred choice for young patients or those refusing meds due to weight gain. Best metabolic profile of the oral SGAs.

Quick reference

Class & Role

SGA / Partial Agonist — Unique 'third-generation' antipsychotic.

Route / Formulation

Tablets (2 mg to 30 mg). (Abilify, Abilify Maintena (LAI))

Usual Dose & Max

PO 10-15 mg OD (morning). Max 30 mg/day.

Key Indication Doses

Schizophrenia: PO 10-15 mg OD (morning). Max 30 mg/day. Bipolar Maintenance: PO 15 mg OD. Adjunct for Depression: PO 2-5 mg OD (Off-label). Elderly / Frail: PO 5-10 mg OD (morning). Max 10 mg/day in elderly. Lower starting dose preferred due to akathisia risk.

Best Uses

Aripiprazole is a unique partial dopamine agonist antipsychotic with the lowest metabolic risk in its class, but can cause paradoxical akathisia and activation early in treatment.

Avoid / Cautions

Known severe hypersensitivity. Pregnancy Category C.

Key Risks

Neurological: Akathisia (intense, agonizing inner restlessness and inability to sit still). Often mistaken for worsening agitation. HIGH — Insomnia, activating effects. Metabolic: Highly weight-neutral, zero prolactin elevation (in fact, it lowers prolactin). Psychiatric: Impulse control disorders (gambling, hypersexuality) due to partial D2 agonism in the reward pathways.

Key Interactions

CYP2D6 inhibitors (Fluoxetine, Paroxetine) or CYP3A4 inhibitors (Clarithromycin) require the Aripiprazole dose to be halved. Carbamazepine/Phenytoin (CYP inducers) will wipe out Aripiprazole levels; dose must be doubled.

Monitoring

Monitor for Akathisia. If the patient is constantly pacing or rocking from foot to foot, they need dose reduction, Propranolol, or a medication switch. Baseline BSL and Lipids (though lowest risk).

Clinical Pearl

Because Aripiprazole is a partial dopamine agonist, it stimulates the pituitary to stop making prolactin. It is often co-prescribed with Risperidone or Haloperidol specifically to reverse their hyperprolactinemia side effects.

Access

Authority requiredAbilify, Abilify Maintena (LAI)2 mg tablet

Brand: Abilify, Abilify Maintena (LAI)
PBS status: Authority required
Formulation: Tablets (2 mg to 30 mg)

Aripiprazole

SGA / Partial Agonist·Psychiatry - Antipsychotics

Schizophrenia, Bipolar I disorder

Authority requiredPBSSGAAbilify, Abilify Maintena (LAI)2 mg tablet+2

Max Dose

30 mg/day

Half-life

75 h

Akathisia

HIGH RISK

Metabolic

LOW RISK

Rapid Summary

Overview

Unique 'third-generation' antipsychotic. Acts as a partial D2 agonist. Highly activating, weight-neutral, but notorious for causing severe akathisia.

Maximum Dose

Max 30 mg/day.

Clinical Focus

Very long half-life (75 hours). Takes up to 2 weeks to reach steady state. Do not up-titrate too quickly.

Bottom Line

Aripiprazole is a unique partial dopamine agonist antipsychotic with the lowest metabolic risk in its class, but can cause paradoxical akathisia and activation early in treatment.

Formulation & Access

Brand Names

Abilify, Abilify Maintena (LAI)

Oral Routes

Tablets (2 mg to 30 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia, Bipolar I disorder.

Off-Label

OFF

Treatment-resistant major depressive disorder (adjunct).

Clinical Place

Preferred choice for young patients or those refusing meds due to weight gain. Best metabolic profile of the oral SGAs.

Quick reference

Class & Role

SGA / Partial Agonist — Unique 'third-generation' antipsychotic.

Route / Formulation

Tablets (2 mg to 30 mg). (Abilify, Abilify Maintena (LAI))

Usual Dose & Max

PO 10-15 mg OD (morning). Max 30 mg/day.

Key Indication Doses

Best Uses

Aripiprazole is a unique partial dopamine agonist antipsychotic with the lowest metabolic risk in its class, but can cause paradoxical akathisia and activation early in treatment.

Avoid / Cautions

Known severe hypersensitivity. Pregnancy Category C.

Key Risks

Key Interactions

Monitoring

Monitor for Akathisia. If the patient is constantly pacing or rocking from foot to foot, they need dose reduction, Propranolol, or a medication switch. Baseline BSL and Lipids (though lowest risk).

Clinical Pearl

Access

Authority requiredAbilify, Abilify Maintena (LAI)2 mg tablet

Brand: Abilify, Abilify Maintena (LAI)
PBS status: Authority required
Formulation: Tablets (2 mg to 30 mg)