A UK consensus on the administration of aripiprazole for the treatment of mania

• Published in: Journal of psychopharmacology (Oxford) 2009-05, Vol.23 (3), p.231-240
• Main Authors: Aitchison, KJ, Bienroth, M, Cookson, J, Gray, R, Haddad, PM, Moore, B, Ratna, L, Sullivan, G, Taylor, D, Taylor, M, Goodwin, GM
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Affective disorders; Agitation; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Antipsychotics; Aripiprazole; Biological and medical sciences; Bipolar Disorder - drug therapy; Bipolar disorders; Clinical trials; Clinical Trials as Topic; Humans; Insomnia; Literature reviews; Mania; Medical sciences; Mood disorders; Nausea; Neuropharmacology; Pharmacology; Pharmacology. Drug treatments; Piperazines - administration & dosage; Piperazines - adverse effects; Piperazines - therapeutic use; Practice Guidelines as Topic; Practice Patterns, Physicians; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Quinolones - administration & dosage; Quinolones - adverse effects; Quinolones - therapeutic use; Side effects; Sleep disorders; United Kingdom - epidemiology
• ISSN: 0269-8811; 1461-7285
• DOI: 10.1177/0269881108098820

Abstract Aripiprazole has recently received approval for the treatment of moderate to severe manic episodes in bipolar I disorder and prevention of new manic episodes in aripiprazole-responsive patients. Aripiprazole differs from other antipsychotics in its pharmacology, and the need for prescribing guidance in the UK was recently identified. A UK multidisciplinary panel was convened in November 2007. This report describes the consensus agreed during the meeting on the optimal approach to prescribing aripiprazole: how best to approach initiation of, and switching to, treatment with aripiprazole and management strategies for side effects. A literature review of the randomised controlled clinical trials of aripiprazole in mania supports these recommendations. Aripiprazole should be initiated at 15 mg/day (range 5–20 mg/day). If necessary, adjunctive medication should be used in early treatment to manage side effects or assist in management of symptoms such as agitation. When switching to aripiprazole, the therapeutic dose of current treatment should be maintained while adding aripiprazole 15 (5–20) mg/day. Only once an effective dose of aripiprazole is reached should previous medication be reduced. Nausea, insomnia and agitation typically resolve within days. Some principles for dosing and switching are provided to assist with a successful treatment outcome with aripiprazole in mania.