title: A UK consensus on the administration of aripiprazole for the treatment of mania.
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.
authors.affiliation: MRC Social, Genetic and Development Psychiatry Centre (MRC), Institute of Psychiatry at King's College London, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Aitchison
authors.forename: M
authors.initials: M
authors.lastname: Bienroth
authors.forename: J
authors.initials: J
authors.lastname: Cookson
authors.forename: R
authors.initials: R
authors.lastname: Gray
authors.forename: P M
authors.initials: PM
authors.lastname: Haddad
authors.forename: B
authors.initials: B
authors.lastname: Moore
authors.forename: L
authors.initials: L
authors.lastname: Ratna
authors.forename: G
authors.initials: G
authors.lastname: Sullivan
authors.forename: D
authors.initials: D
authors.lastname: Taylor
authors.forename: M
authors.initials: M
authors.lastname: Taylor
authors.forename: G M
authors.initials: GM
authors.lastname: Goodwin
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D001714:Bipolar Disorder / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015363:Quinolones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole