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

MRC Social, Genetic and Development Psychiatry Centre (MRC), Institute of Psychiatry at King’s College London, London, UK

M Bienroth

Stepping Stones CMHT, OXLEAS NHS Foundation Trust, Bromley, Kent, UK

J Cookson

Royal London Hospital, Mile End Hospital, London, UK

R Gray

Faculty of Health, University of East Anglia, Norwich, UK

PM Haddad

Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK

B Moore

Hollins Park Hospital, 5 Boroughs Partnership NHS Trust, Warrington, UK

L Ratna

Barnet Psychiatric Unit, The Burroughs, London, UK

G Sullivan

School of Care Sciences, University of Glamorgan, Pontypridd, UK

D Taylor

Maudsley Hospital, South London and Maudsley NHS Trust, London, UK

M Taylor

Springpark Centre, Greater Glasgow and Clyde Primary Care Division, Glasgow, UK

GM Goodwin

Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK guy.goodwin{at}psych.ox.ac.uk

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.

Key Words: bipolar disorder/drug therapy • mania • antipsychotic agents/therapeutic use • antipsychotic agents/administration and dosage • guideline • algorithms

This version was published on May 1, 2009

Journal of Psychopharmacology, Vol. 23, No. 3, 231-240 (2009)
DOI: 10.1177/0269881108098820


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