Is Aripiprazole safe for my elderly father with bipolar?

Question

Hello doctor,

My father is 65 years old. He has bipolar disorder for 40 years. He also has diabetes. He is taking medicine for high blood pressure.

For a very long time, he took Lithium 1000 mg and Oxcarbazepine 900 mg. Two to three episodes used to happen, usually a long manic spell followed by a gloomy or less active spell. He stopped Lithium due to toxicity, as even a low dose was toxic for him. He started taking Quetiapine 200 mg at night. During manic spells, he used to take up to Aripiprazole 30 mg for two to three months.

Considering his age and other medical conditions, what should be the right combination of medicines? Is Aripiprazole safe? (It is very effective in treating his mania.) Now he has stopped taking Aripiprazole, and he is doing fine. However, he complains of restlessness at times. He feels like he does not want to sit in one place. What should be given to him in this post-mania phase? Please ask if you need any more details.

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

I have read through your query in detail. Please find my observations below.

Medicines for mental health conditions should be taken under the strict supervision of the psychiatrist. As mentioned above, lithium toxicity is a serious concern and it is good that you have stopped lithium due to toxicity.

Quetiapine is an atypical antipsychotic medication and studies have shown that it is a safe and effective medication for the elderly. The side effects are less when the patient takes Quetiapine.

Transient hypotension, dizziness, and somnolence are the only side effects in patients and is seen rarely. Long term use of Quetiapine has shown no serious side effects in the elderly.

Aripiprazole is good medicine but might cause agitation and activation in about 8 percent of elderly people who take it. Studies show that in most patients Aripiprazole can be continued at a dose of 10 to 15 mg/day. Aripiprazole has less metabolic side effects than other medicines.

Side effects of Aripiprazole include dizziness, weakness, lightheadedness, nausea, vomiting, stomach upset, tiredness, excess saliva or drooling, choking or trouble in swallowing, blurred vision, headache, anxiety, weight gain, drowsiness, sleep problems (insomnia) and constipation.

There is a little increase in the risk of stroke in the elderly due to the intake of antipsychotic medicines, though this is very less. It is very important to go into details of patient problems when prescribing and changing doses of medicines.

I hope your father is managing well with his diabetes and blood pressure.

Considering the above, it is best to prescribe medicines based on benefit and risk. Some patients might do well without medicine without much bipolar symptoms and in the absence of frequent attacks, however many require medicines like your father.

There is no fixed regimen over one medicine being better than the rest but medicine like Aripiprazole has fewer side effects.

Can you please let us know the treatment he has undertaken in the last 2 years, including medicine name and duration for which it was taken, dose, symptoms, and improvements.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

1. Please change the medications only under the recommendation of the treating psychiatrist and after clinical evaluation. The following are only suggestions based on information given by you. Patients with diabetes and hypertension have a limited choice of antipsychotic medications and require medications to be taken on an individual basis.2. Oxcarbazepine is a good alternative to lithium. However, if he is taking Quetiapine, then that is better.3. Right now:

Either Quetiapine or Aripiprazole (anyone medicine and not both) requires to be given although he is in post mania. If nothing is given, then there is a higher chance of relapse.
Rivotril (Clonazepam) might be given in split doses, 0.25 mg in the morning and 0.5 mg at night for restlessness and disturbed sleep. 2 mg is a slightly higher dose and is usually given only if patients develop tolerance. This has to be taken for 2 weeks and subsequently tapered and terminated. This is because few elderly patients might have side effects with long term use of Rivotril.

Thank you.