A UK consensus on the administration of aripiprazole for the treatmentof mania
Aitchison, K., Bienroth, M., Cookson, J., Gray, R., Haddad, P., Moore, B., Ratna, L., Sullivan, D., Taylor, D., Taylor, M. and Goodwin, G. (2009) A UK consensus on the administration of aripiprazole for the treatmentof mania. Journal of Psychopharmacology , 23 (3). pp. 231-240. ISSN 0269-8811
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Publisher's URL: http://dx.doi.org/10.1177/0269881108098820
Aripiprazole has recently received approval for the treatment of moderateto severe manic episodes in bipolar I disorder and prevention of newmanic episodes in aripiprazole-responsive patients. Aripiprazole differsfrom other antipsychotics in its pharmacology, and the need for prescribing guidance in the UK was recently identified. A UKmultidisciplinary 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 strategiesfor 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 tomanage 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 medicationbe 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.