Aripiprazole withdrawal
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Aripiprazole Withdrawal: Insights and Implications
Introduction to Aripiprazole Withdrawal
Aripiprazole, an atypical antipsychotic, is widely used for treating various psychiatric conditions, including bipolar disorder and schizophrenia. However, discontinuation or withdrawal from aripiprazole can lead to significant adverse effects, which are crucial for clinicians to understand and manage effectively.
Withdrawal Emergent Dyskinesia
One of the notable withdrawal symptoms is withdrawal emergent dyskinesia. A case report highlighted a 65-year-old woman with bipolar I disorder who developed significant dyskinesia, characterized by tongue rolling and lip smacking, after switching from aripiprazole to quetiapine. This condition improved after increasing the dose of quetiapine1. This case underscores the importance of monitoring for dyskinesia in patients discontinuing aripiprazole, especially those without a history of tardive dyskinesia.
Pulmonary Hypertension and Respiratory Distress in Newborns
Withdrawal symptoms are not limited to adults. A study reported a case of a newborn developing pulmonary hypertension and respiratory distress following in utero exposure to aripiprazole. This highlights the potential risks associated with aripiprazole use during pregnancy and the need for careful monitoring of newborns exposed to the drug5.
Exacerbation of Psychotic Symptoms
Sudden withdrawal of aripiprazole can also exacerbate psychotic symptoms. In a study involving methamphetamine-associated psychosis, patients experienced severe exacerbation of psychosis after the abrupt discontinuation of chlorpromazine and initiation of aripiprazole. This suggests that the partial agonistic activity of aripiprazole at D2 receptors may contribute to worsening psychosis in certain contexts8.
Maintenance Treatment and Withdrawal Studies
Several studies have evaluated the efficacy and safety of aripiprazole in maintenance treatment, which indirectly provides insights into withdrawal effects. For instance, a double-blind, placebo-controlled study on aripiprazole once-monthly 400 mg (AOM 400) for bipolar I disorder showed that discontinuation led to a higher recurrence of mood episodes compared to those who continued the treatment2 3. This indicates the importance of gradual tapering and close monitoring during withdrawal to prevent relapse.
Conclusion
Aripiprazole withdrawal can lead to various adverse effects, including dyskinesia, pulmonary hypertension in newborns, and exacerbation of psychotic symptoms. These findings highlight the need for careful management and monitoring during the discontinuation process. Gradual tapering and alternative treatments may help mitigate these withdrawal symptoms, ensuring better outcomes for patients transitioning off aripiprazole.
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Aripiprazole withdrawal
Aripiprazole withdrawal can cause withdrawal emergent dyskinesia, a common symptom of antipsychotic discontinuation or dosage reduction after long-term use.
Case ReportEfficacy and Safety of Aripiprazole Once-Monthly in the Maintenance Treatment of Bipolar I Disorder: A Double-Blind, Placebo-Controlled, 52-Week Randomized Withdrawal Study.
Aripiprazole once-monthly 400 mg effectively delays mood episode recurrence and is generally safe and well-tolerated for maintenance treatment of bipolar I disorder.
RCT
Highly CitedThe safety and tolerability of aripiprazole once-monthly as maintenance treatment for bipolar I disorder: A double-blind, placebo-controlled, randomized withdrawal study.
Aripiprazole once-monthly 400 mg is a well-tolerated maintenance treatment for bipolar I disorder with time-limited adverse events.
RCT
Rigorous JournalOral Aripiprazole as Maintenance Treatment in Adolescent Schizophrenia: Results From a 52-Week, Randomized, Placebo-Controlled Withdrawal Study.
Aripiprazole is a safe and effective maintenance treatment for adolescents with schizophrenia, reducing relapse risk and reducing serious adverse events.
RCTAripiprazole withdrawal
Aripiprazole withdrawal can lead to pulmonary hypertension and respiratory distress in newborns exposed to the drug during pregnancy and near delivery.
Case ReportDouble-blind, randomized, placebo-controlled long-term maintenance study of aripiprazole in children with bipolar disorder.
Aripiprazole may be superior to placebo in long-term treatment of pediatric patients with bipolar disorder, despite the possibility of a nocebo effect.
RCTAripiprazole in the treatment of patients with alcohol dependence: a double-blind, comparison trial vs. Naltrexone
Aripiprazole shows potential in reducing alcohol use and cravings in alcohol-dependent patients, but craving scores show better results with naltrexone.
RCTRigorous JournalHighly CitedSevere Exacerbation of Psychosis After Sudden Withdrawal of Chlorpromazine in the Treatment of Methamphetamine-Associated Psychosis With Aripiprazole and Chlorpromazine: 2 Case Reports
Sudden withdrawal of chlorpromazine may lead to severe exacerbation of psychotic symptoms in methamphetamine-associated psychosis patients.
Case ReportRigorous JournalSymptoms and functioning with aripiprazole once-monthly injection as maintenance treatment for bipolar I disorder.
AOM 400 effectively maintains symptom and functional improvements in patients with bipolar I disorder after a manic episode, compared to placebo.
RCTRigorous JournalAripiprazole in acute treatment of children and adolescents with autism spectrum disorder: a systematic review and meta-analysis
Aripiprazole is effective in treating behavioral disturbances in children and adolescents with autism spectrum disorder, but not lethargy/social withdrawal.
Meta-Analysis