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Aripiprazole

What is aripiprazole?

The primary treatments for bipolar disorder are pharmacological, and often involve second generation antipsychotic drugs such as aripiprazole. Aripiprazole is is a partial agonist of dopamine D2 and serotonin 5-HT1A receptors and an antagonist of 5-HT2A receptors. It has a distinct receptor-binding profile compared to other second generation antipsychotic drugs.

What is the evidence for aripiprazole as a treatment for bipolar disorder?

Mania and psychotic symptoms

Moderate quality evidence suggests a small effect of greater improvement with aripiprazole than with placebo. The effect for mania is large in pediatric patients. There were no differences in mania symptoms between aripiprazole and other medications, however, there were large effects of more switching to mania with aripiprazole than with quetiapine or ziprasidone.

Depressive symptoms

Moderate to high quality evidence suggests no significant differences between aripiprazole and placebo for depression. Moderate quality evidence suggests less improvement in depression, less response to treatment, and less likelihood of remission with aripiprazole than with lurasidone.

Overall symptoms and prevention of relapse

Moderate quality evidence suggests greater overall improvement in symptoms with aripiprazole than with haloperidol or lithium. There were medium-sized effects of fewer relapses with aripiprazole + valproate or aripiprazole + lamotrigine than with placebo. There were also fewer relapses with aripiprazole + valproate than with paliperidone or imipramine. Also see the topics on relapse prevention and polypharmacy.

Side effects

Moderate quality evidence suggests more high-density lipoprotein, sedation, extrapyramidal symptoms, constipation, nausea, vomiting, anxiety, salivation, fatigue, insomnia, and pain in the extremities with aripiprazole than with placebo. However, there was less hyperprolactinemia, less elevated fasting glucose, less increased appetite, and less total cholesterol with aripiprazole.

November 2021

Image: ©Darwin Brandis – stock.adobe.com

Last updated at: 6:44 pm, 13th February 2022
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