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Aripiprazole in patients with bipolar mania and beyond: an update of practical guidance

Forskningsöversiktsartikel
Författare GM Goodwin
M Abbar
TE Schlaepfer
H Grunze
RW Licht
F Bellivier
KN Fountoulakis
AC Altamura
W Pitchot
Hans Ågren
E Holsboer-Trachsler
E Vieta
Publicerad i CURRENT MEDICAL RESEARCH AND OPINION
Volym 27
Nummer/häfte 12
Sidor 2285-2299
ISSN 0300-7995
Publiceringsår 2011
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi
Sidor 2285-2299
Språk en
Länkar dx.doi.org/10.1185/03007995.2011.62...
Ämnesord aripiprazole, atypical antipsychotic, bipolar disorder, clinical use, mania, review, sedation
Ämneskategorier Farmaceutisk vetenskap

Sammanfattning

BACKGROUND: Aripiprazole is an atypical antipsychotic with a pharmacological and clinical profile distinct from other atypical antipsychotics. SCOPE: A European multidisciplinary advisory panel of university-based experts in bipolar disorders convened in April 2010 to review new clinical guidelines for the management of mania and the role of aripiprazole in its treatment. This report describes the consensus reached on how best to use aripiprazole in the treatment of mania. FINDINGS: Current guidelines recommending aripiprazole for first-line treatment of mania have not generally translated to clinical practice. The panel agreed that clinicians may not feel sufficiently knowledgeable on how to use aripiprazole effectively in mania, and that the perception that aripiprazole is less sedating than other antipschotics may hamper its use. There was consensus about the importance of ensuring that clinicians understood the distinction between antimanic efficacy and sedation. Most acutely manic patients may require night-time sedation, but continuous daytime sedation is not necessarily indicated and may interfere with long-term compliance. If sedation is necessary, guidelines recommend the use of adjunctive benzodiazepines only for a short-time. CONCLUSIONS: Clinical practice guidelines widely recommend aripiprazole as a first-line treatment for mania. Although clinical trials may not represent all patient subpopulations, they show that aripiprazole is well tolerated and has a long-term stabilizing potential. The successful use of aripiprazole rests on using the appropriate initial dose, titrating and adjusting the dose as needed and using appropriate concomitant medication to minimize any short-term adverse events. Low incidence of sedation makes aripiprazole a reasonable long-term treatment choice. If short-term sedation is required an adjunctive sedative agent can be added and removed when no longer needed. Clinical considerations should influence treatment choice, and a better distinction between sedation and antimanic effects should be an educational target aimed to overcome potential barriers for using non-sedative antimanic agents such as aripiprazole.

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