Bottom Line:
Aripiprazole is a good choice for minimizing risk of weight gain and metabolic side effects, but beware of akathisia. Its many indications and wide range of effective doses make individualized dosing unpredictable.

FDA Indications:
Schizophrenia (adults, adolescents 13+); bipolar disorder—acute manic/mixed episodes (adults, children 10+); bipolar maintenance (adults); major depression (adjunct, adults); irritability in autism (children 6+); Tourette’s disorder (children 6+).

Off-Label Uses:
Bipolar depression; behavioral disturbances.

Dosage Forms:
Tablets (G): 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg.
Orally disintegrating tablets (G): 10 mg, 15 mg, 20 mg, 30 mg.
Oral liquid (G): 1 mg/mL.
Long-acting injections (LAIs): Abilify Maintena 300 mg, 400 mg; Abilify Asimtufii 720 mg, 960 mg; Aristada 441 mg, 662 mg, 882 mg, 1064 mg; Aristada Initio 675 mg (see LAI fact sheet).
Tablet with sensor (Abilify MyCite): 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg.

Dosage Guidance:

• Schizophrenia & bipolar disorder: Adults: Start/target 10–15 mg/day; max 30 mg/day. Children: Start 2 mg/day; ↑ to 5 mg/day on day 3; ↑ by 5 mg/day weekly to target 10 mg/day; max 30 mg/day.
• Irritability in autism: Start 2 mg/day; ↑ weekly to 5–10 mg/day; max 15 mg/day.
• Depression (adjunct): Start 2–5 mg/day; increase to 5–10 mg/day. Titrate slowly to reduce agitation/akathisia. Max 15 mg/day.
• Tourette’s: Start 2 mg/day; target 5 mg/day; max 10 mg/day (<50 kg) or 20 mg/day (>50 kg).
• LAIs: See LAI fact sheet and table.
• Liquid dosing: Oral solution ≈ tablet doses up to 25 mg; substitute 25 mg solution for 30 mg tablet.
• ODTs: Same dosing as tablets.
• Dose timing: May be taken morning or night; can unpredictably cause sedation or insomnia.

Monitoring: Fasting glucose, lipids.

Cost: $; ODTs: $$$; liquid and LAI: $$$$$

Side Effects:

• Most common: Akathisia, anxiety, insomnia, sedation, tremors.
• Serious but rare: See class warnings. Rare impulse-control problems (gambling, eating, shopping, sexual urges).
• Pregnancy/breastfeeding: Considered relatively safe.

Mechanism, Pharmacokinetics, and Drug Interactions:

• Dopamine D2 and serotonin 5-HT1A partial agonist; 5-HT2A antagonist.
• Metabolized by CYP2D6 and 3A4; half-life: 3–6 days.
• Use half dose with 2D6 or 3A4 inhibitors or in 2D6 poor metabolizers; quarter dose if both apply; double dose with 3A4 inducers.

Clinical Pearls:

• Low-dose aripiprazole may reduce antipsychotic-induced hyperprolactinemia.
• Abilify MyCite contains an ingestible sensor that tracks adherence; available only via specialty pharmacy.

Fun Fact:
Mezofy and Opipza—new oral film formulations of aripiprazole—have been approved and are expected to launch in early 2026.