High dose aripiprazole – clinical use

Abstract

Aripiprazole is a second-generation antipsychotic medication, with a dual mechanism of antagonist and agonist on the receptors D2. Despite the fact that it has been present on the Polish market for over a dozen years, and for several years in the form of the long-acting injections, for many doctors, it is not the drug of the first choice in the first episode of psychosis or mania, especially with accompanying psychomotor agitation. It also has an unjust opinion that it can exacerbate psychotic symptoms or increase agitation and the risk of aggression. However, it is more often used as a second-line drug in the presence of metabolic disorders or hyperprolactinaemia, as well as in the case of persistent negative symptoms. Multiple studies and meta-analyses suggest no benefit from aripi­prazole doses above 20 mg/day, but registered dosages are as high as 30 mg/day. This article aims to provide an overview of the available data and clinical cases with higher doses, i.e. above 15 aripiprazole per day, which may be useful in the treatment of manic episodes and some cases of schizophrenia, among others.