Advances in the treatment of mania: Aripiprazole

Programa de Trastornos Bipolares, Instituto Clínico de Neurociencias, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBER-SAM, Barcelona.
Actas espanolas de psiquiatria (Impact Factor: 1.2). 05/2008; 36(3):158-64.
Source: PubMed


Aripiprazole is a dopamine partial agonist antipsychotic drug that has just been approved in Europe for its use in the treatment of acute mania and for the prevention of manic episodes in bipolar disorder. Its efficacy in mania is superior to that of placebo, both as monotherapy and as adjunctive therapy, and comparable to that of haloperidol and lithium. From the safety perspective it is remarkable that it is not highly sedative and does not impair the metabolic parameters. The advantages of a non-sedative and metabolically neutral antimanic drug are particularly relevant in the long-term, due to their impact on cognition and quality of life. The experience on its use in routine clinical practice indicates that in order to avoid phenomena such as activation, abrupt worsening or akathisia, it is recommendable to start treatment with low doses and to increase them progressively, especially in those patients who are already receiving other drugs; moreover, it is advisable not to stop abruptly any ongoing treatment, unless there is an emergency, to transiently prescribe a concomitant benzodiazepine, and to maintain the dose that proved efficacious during the short term treatment during maintenance therapy.

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    • "The mechanism of sinus tachycardia remains unknown, as aripiprazole possess no affinity for noradrenergic or cholinergic receptors (Otsuka 2014). Possible etiologies include the effect of other drugs, such as clozapine combined with aripiprazole (Nielsen et al. 2013), or akathisia/activation seen at times during the initial phase of aripiprazole treatment (Vieta and Franco 2008). "
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