Magazine article Clinical Psychiatry News

Aripiprazole: Dosing Tips and Prescribing Pearls

Magazine article Clinical Psychiatry News

Aripiprazole: Dosing Tips and Prescribing Pearls

Article excerpt

Brands * Abilify

Generic not available in the United States, Europe, or Japan

Class * Dopamine stabilizer

Dopamine partial agonist, atypical antipsychotic, third generation antipsychotic; sometimes added as a second-generation antipsychotic; also a mood stabilizer

Dosing Tips

** Most patients, particularly patients not acutely psychotic, may need a lower dose (5-10 mg/day) to avoid akathisia and activation and for maximum tolerability

** Although infrequent, patients may need to be dosed higher than the recommended 30 mg/day

** Halving 5 mg tablets (not scored) may be beneficial for children and adults who are sensitive to side effects

** Patients switching from another antipsychotic to aripiprazole may respond better to adding a full dose of aripiprazole to the maintenance dose of the first antipsychotic for a few days prior to slow down-titration of the first antipsychotic, rather than rapid switch or cross-titration

** Augmenting aripiprazole with a benzodiazepine or a conventional antipsychotic, orally or intramuscularly, may be more effective in treating acutely agitated patients than raising dosage levels

** Partial responders may improve with the addition of a mood-stabilizing anticonvulsant, such as valproate or lamotrigine, instead of an increased dose of aripiprazole

** A single missed dose is generally not necessary to make up, but if psychosis reactivates after several missed doses, the patient may need a higher dose for a short term to restabilize

** Generally, children and elderly should be dosed at the lower end of the spectrum

** Depending on the dose administered, aripiprazole can be more or less expensive than other antipsychotics

Pearls

** Causes less weight gain than most other antipsychotics

** Causes less sedation than most other antipsychotics

** Can even be activating, but this effect can be reduced by lowering the dose or starting at a low dose

** Moderately priced drug for the dosing range

** Carries a lower risk of diabetes, dyslipidemia, and hyperglycemia than some other antipsychotics

** Anecdotal reports of efficacy in treatment-resistant cases

** Clinical practice has found its tolerability profile very favorable

Adapted from Stahl SM. …

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