Aripiprazole
- 1 January 2012
- journal article
- review article
- Published by Springer Science and Business Media LLC in Drugs
- Vol. 72 (1), 133-162
- https://doi.org/10.2165/11208320-000000000-00000
Abstract
Aripiprazole (Abilify®) is an atypical antipsychotic indicated for the treatment of mania associated with bipolar I disorder. It is unique in its class, as it is a partial agonist of dopamine D2 and D3, and serotonin 5-HT1A receptors and a modest antagonist of 5-HT2a receptors. This article reviews the pharmacological properties, clinical efficacy and tolerability of oral aripiprazole in the management of mania associated with bipolar I disorder in adults. In well designed clinical trials in patients with recent manic or mixed episodes associated with bipolar I disorder, oral aripiprazole monotherapy or adjunctive therapy to lithium or valproate improved symptoms of mania following short-term (≤12 weeks) or maintenance (≤100 weeks) treatment. In addition, maintenance treatment with aripiprazole (as monotherapy or adjunctive therapy) prevented the recurrence of any mood episodes or manic episodes (but not depressive episodes) in patients who had previously been stabilized and maintained on aripiprazole. Aripiprazole was generally well tolerated in these studies and was associated with a low risk of prolactin elevation, corrected QT interval prolongation and metabolic disturbances. Extrapyramidal symptoms occurred in up to 28% of aripiprazole recipients, but after longer-term treatment (≤100 weeks), symptom severity did not differ significantly from that in placebo recipients. Aripiprazole treatment generally did not increase bodyweight to a clinically relevant extent; however, more patients receiving aripiprazole monotherapy than placebo had clinically significant bodyweight gain during 100 weeks’ treatment. Additionally, in a comparative trial, aripiprazole monotherapy was at least as effective as haloperidol monotherapy in terms of improving symptoms of mania, but had the advantage of a lower incidence of some adverse events, such as extrapyramidal symptom-related adverse events. Further trials comparing aripiprazole with other agents, including atypical antipsychotics, would help to definitively position aripiprazole relative to these agents. Current guidelines recommend aripiprazole as a first-line option (as monotherapy or adjunctive therapy) for the short-term treatment of mania associated with bipolar I disorder, and as a first-line (as monotherapy) or second-line (as adjunctive therapy) option for preventing the recurrence of mood episodes during longer-term therapy.Keywords
This publication has 76 references indexed in Scilit:
- A 52-Week, Double-Blind Evaluation of the Metabolic Effects of Aripiprazole and Lithium in Bipolar I DisorderThe Primary Care Companion For CNS Disorders, 2011
- Aripiprazole in the Maintenance Treatment of Bipolar Disorder: A Critical Review of the Evidence and Its Dissemination into the Scientific LiteraturePLoS Medicine, 2011
- Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey InitiativeArchives of General Psychiatry, 2011
- One-year risk of psychiatric hospitalization and associated treatment costs in bipolar disorder treated with atypical antipsychotics: a retrospective claims database analysisBMC Psychiatry, 2011
- Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled TrialsNeuropsychopharmacology, 2010
- Metabolic Syndrome in Patients Enrolled in a Clinical Trial of Aripiprazole in the Maintenance Treatment of Bipolar I DisorderThe Journal of Clinical Psychiatry, 2010
- Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysisAnnals of General Psychiatry, 2009
- Aripiprazole monotherapy in patients with rapid-cycling bipolar I disorder: an analysis from a long-term, double-blind, placebo-controlled studyPublished by Hindawi Limited ,2008
- Intramuscular AripiprazoleCNS Drugs, 2008
- AripiprazoleDrugs, 2004