Aripiprazole Dosing for Bipolar Mania
For treating bipolar mania, aripiprazole should be initiated at 15 mg/day and can be adjusted between 10-30 mg/day based on response and tolerability. 1
Initial Dosing
- Start with 15 mg once daily for acute manic episodes 1
- Dose can be adjusted down to 5-10 mg/day if side effects occur or up to 30 mg/day if needed for symptom control 1
- Allow at least 2 weeks before making dose adjustments to reach steady state 2
- Full therapeutic effect may take 1-4 weeks to achieve 2
Dosing Considerations by Age
- For adolescents (≥13 years), the recommended dose is 10 mg once daily for 12 weeks 3
- Higher doses (30 mg/day) show less favorable tolerability compared to lower doses (10 mg/day) in younger patients 3
- For adults, doses between 10-30 mg/day have been systematically evaluated and shown to be effective 2
Combination Therapy
- When switching to aripiprazole from another medication, maintain the therapeutic dose of current medication while adding aripiprazole at 5-15 mg/day 1
- Adjust aripiprazole between 10-30 mg/day based on response and tolerability before gradually discontinuing the prior medication 1
- Aripiprazole can be used as adjunctive treatment with mood stabilizers like lithium or valproate for more severe presentations 4
Efficacy Considerations
- Aripiprazole is more effective than placebo in reducing manic symptoms at three and four weeks but this difference may not persist at six weeks 5
- No statistically significant differences were found between aripiprazole and other treatments (lithium, haloperidol) in reducing manic symptoms at three weeks 5
- Aripiprazole is an effective treatment for mania in both adults and adolescents 5
Side Effect Management
- Monitor for movement disorders, as aripiprazole can cause akathisia and other extrapyramidal symptoms 5
- Watch for gastrointestinal disturbances like nausea and constipation 5
- In adolescents, monitor for changes in prolactin levels 5
- Side effects, if they occur, are usually manageable and frequently resolve soon after initiation 1
Common Pitfalls to Avoid
- Inadequate duration of maintenance therapy can lead to high relapse rates 4
- Premature discontinuation of effective medications increases risk of relapse 4
- Avoid antidepressant monotherapy as it may trigger manic episodes or rapid cycling 4
- Failure to monitor for metabolic side effects is a common pitfall 4
Alternative First-Line Options
- The American Academy of Child and Adolescent Psychiatry recommends lithium, valproate, or atypical antipsychotics (including aripiprazole) for acute mania/mixed episodes 4
- For females of childbearing potential, lithium may be preferred over valproate due to teratogenic risk 6
- For maintenance therapy, lithium shows superior evidence for prevention of both manic and depressive episodes 4