Sunday, May 8, 2016

Aripiprazole causes impulse, FDA says

The US Food and Drug Administration (FDA) made a publication warn that aripiprazole, an antipsychotic drug, can cause some kind of impulsiveness.

According to FDA, this impulsiveness represents uncontrollable urges to gamble, binge eat, shop, and have sex. These symptoms are rarely observed, but deserve to be covered, as they may result in harm to the patient and others.

FDA: FDA Drug Safety Communication: FDA warns about new impulse-control problems associated with mental health drug aripiprazole (Abilify, Abilify Maintena, Aristada)

The fact aripiprazole can cause compulsive gambling has been recognized so far. However, the FDA considers that other similar maladaptive behaviors should also be listed as an adverse effect of aripiprazole. Patients and caregivers should be notified about these risks in advance of taking aripiprazole.

I wonder why the FDA made a decision to publish this alert at present. Many clinicians know the fact that aripiprazole can drive impulsiveness. It is deeply connected to its cellular function. Aripiprazole has a role of dopamine system stabilizer.

In the patients in which internal dopamine in the brain is excessively released, it blocks dopamine receptors. But if dopamine is exhausted, aripiprazole works as if it is internal dopamine. Therefore, the occupation rate of dopamine receptor in the midbrain is modified to the proper level, theoretically. However, in some patients, the concentration of dopamine receptors is altered for some reasons. In these cases, aripiprazole can stimulate dopamine receptors dramatically. Dopamine is concerned to impulsiveness in human emotion. It is a theoretical explanation of aripiprazole-induced impulsiveness.

In my experience, aripiprazole is an effective option for patients with bipolar disorders, depression, ADHD, autism, as well as schizophrenia. In recent years, it was tried to treat mood symptoms and hallucination in patients with Parkinson’s disease. But this attempt resulted in a failure. Now, the literature suggests it is not recommended. Some patients with Parkinson’s disease become impulsive after taking aripiprazole. It may be because Parkinson’s disease has modified the structure of dopamine receptors in the brain.

Therefore, I think this FDA’s warning is outdated. Of course, clinicians should be aware of this adverse effect. And it will do no more damage the value of aripiprazole as a solution for some patients.

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