Akathisia aripiprazole

Aripiprazole Akathisia, typically weight neutral 15-30 15 mg increments 30... 

The most common side effects associated with aripiprazole include headache, nausea, dyspepsia, agitation, anxiety, insomnia, somnolence, and akathisia. Dose-related adverse events include somnolence and akathisia. Early clinical experience indicates that akathisia may be avoided by starting the medication at doses lower than 10 mg and increasing the dose slowly. Aripiprazole is not associated with significant sedation, anticholinergic side effects, weight gain, or cardiovascular side effects (Petrie et al. 1997). 

Five patients (three women aged 30, 32, and 41 years and two men aged 36 and 56 years), had serious adverse effects developed after starting to take aripiprazole. There was agitation, akathisia, insomnia, and dysphoria three made suicide attempts and two had suicidal thoughts (10). 

Olanzapine, quetiapine, and risperidone are preferred alternative atypicals aripiprazole and ziprasidone are newer agents and may initially cause akathisia-like reactions clozapine is usually reserved for treatment-resistant mania or mixed states. 

Quetiapine has sedative effects and may cause weight gain, bnt it causes minimal extrapyramidal side effects or prolactin elevations. Ziprasidone canses few extrapyramidal side effects, does not significantly increase prolactin levels, and has a lower risk of causing weight gain. Aripiprazole has low extrapyramidal side effects (except for initial akathisia), minimal effect on prolactin levels, and is considered to be weight neutral. 

Antipsychotic drugs are more often used in the treatment of bipolar illness. Lithium was equivalent to aripiprazole, and both were superior to placebo, in a 3-week, double-blind, randomized, placebo-controlled study of acutely manic patients [5 ]. The improvement was maintained for an additional 9 weeks (a total of 12 weeks), with a 12.7 point drop in Young Mania Rating Scale score for lithium and a 14.5 point drop for aripiprazole. The most common adverse events with aripiprazole were headache, nausea, akathisia, sedation, and constipation and with lithium nausea, headache, constipation, and tremor. 

In a multicenter study, out-patients were randomly assigned to adjunctive aripiprazole (15 or 30 mg/day n = 253) or placebo ( = 131) for 6 weeks [62. They had had a manic or mixed episode (with or without psychotic features) with partial non-response to lithium/valproate monotherapy and with target serum concentrations of lithium (0.6-1.0 mmol/1) or valproate (50-125 mgA). Improvement was significantly greater with aripiprazole than with placebo. Withdrawal rates due to adverse reactions were higher with aripiprazole than with placebo (9% versus 5% respectively). Akathisia was the most frequently reported extrapyramidal symptom-related adverse reaction, and it occurred... 

Observational studies In a 6-week, prospective, unrandomized, open study in 20 patients with acute bipolar depression, aripiprazole up to a maximum of 30 mg/ day improved Montgomery-Asberg Depression Rating Scale (MADRS) and Mania Rating Scale (MRS) scores significantly [64 ]. The most fi-equent adverse reactions were nausea and akathisia two patients withdrew because of akathisia. 

In an open 16-week study of the efficacy and tolerability of aripiprazole in 85 patients with bipolar disorder and acute depression inadequately responsive to a mood stabilizer there were significant reductions in mean MADRS and Clinical Global Impression-Severity (CGI-S) scales [65 ]. Three patients withdrew because of adverse reactions, the most common of which was akathisia, which occurred in 21% of subjects there was also a statistically non-significant weight gain (0.9 kg). 

Akathisia FGAs Aripiprazole i Antipsychotic or change to SGA (best = clozapine > quetiapine > olanzapine > risperidone aripiprazole worst) Try propranolol 30-80 mg... 

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