Table 16.6-1. Hierarchical ranking of first-line treatments for the management of manic episodes, with suggested starting doses

Drug

Dosage

First-line monotherapies

Lithium

300-600 mg/d; final dosage depends on serum medication levels, clinical response, and age (see text)

Quetiapine

100 mg/d and increasing daily by 100 mg to a total of 600-800 mg/d

Divalproex

250-500 mg/d (target 1000-1500 mg/d)

Asenapine

5 mg bid (target 5-10 mg bid)

Aripiprazole

15 mg/d (target 15-30 mg/d)

Paliperidone

3 mg/d (target 6-12 mg/d)

Risperidone

2-3 mg/d (target 2-4 mg/d)

Cariprazine

Day 1: 1.5 mg/d; day 2+: 3 mg/d

First-line combination therapies

Quetiapine + lithium/divalproex

 See above

Aripiprazole + lithium/divalproex

 See above

Risperidone + lithium/divalproex

 See above

Asenapine + lithium/divalproex

 See above