Is Abilify (Aripiprazole) causing tachycardia?

From the Guidelines

Abilify (aripiprazole) is not typically associated with a significant increase in heart rate, as evidenced by its minimal effect on QT prolongation 1. When considering the potential for Abilify to cause a fast heart rate, it's essential to look at the broader context of its side effects and how they compare to other antipsychotic medications. According to the study published in Pediatrics 1, aripiprazole has a mean QT prolongation of 0 ms, indicating it does not significantly affect the heart's electrical activity, which can lead to fast heart rates or more severe cardiac issues.

Key points to consider:

• The risk of QT prolongation and associated cardiac issues is more commonly associated with other antipsychotics like thioridazine and droperidol, which have FDA black box warnings 1.
• Aripiprazole's side effect profile, including its lack of significant QT prolongation, makes it a preferable option for patients at risk of cardiac complications 1.
• Monitoring for any changes in heart rate or the development of tachycardia is still crucial, especially in patients with pre-existing heart conditions or those taking other medications that could interact with Abilify 1.

In clinical practice, if a patient on Abilify experiences a fast heart rate, it is crucial to assess for other potential causes and adjust the treatment plan accordingly, rather than immediately attributing the symptom to the medication 1. This might involve reviewing the patient's medication list for potential interactions, assessing for signs of dehydration or other conditions that could contribute to tachycardia, and considering alternative antipsychotic options if necessary.

From the FDA Drug Label

Common adverse reactions (reported in at least 5% of all overdose cases) reported with oral aripiprazole overdosage (alone or in combination with other substances) include vomiting, somnolence, and tremor Other clinically important signs and symptoms observed in one or more patients with aripiprazole overdoses (alone or with other substances) include acidosis, aggression, aspartate aminotransferase increased, atrial fibrillation, bradycardia, coma, confusional state, convulsion, blood creatine phosphokinase increased, depressed level of consciousness, hypertension, hypokalemia, hypotension, lethargy, loss of consciousness, QRS complex prolonged, QT prolonged, pneumonia aspiration, respiratory arrest, status epilepticus, and tachycardia.

• Tachycardia is a possible adverse reaction associated with aripiprazole overdosage, as reported in the drug label 2.
• This suggests that Abilify (aripiprazole) may cause a fast heart rate in some cases, particularly in the context of an overdose.

From the Research

Abilify and Fast Heart Rate

• Abilify, also known as aripiprazole, is an atypical antipsychotic drug that may have effects on the heart rate and QT interval 3, 4.
• A study published in 2018 found that aripiprazole does not increase the QT interval, which is a measure of the heart's electrical activity 3.
• Another study published in 2015 found that aripiprazole has a low risk of cardiac arrhythmias and sudden cardiac death, and that it may actually decrease the mean ΔQTc interval 4.
• However, it is important to note that aripiprazole can cause other side effects, such as akathisia, which is a movement disorder characterized by restlessness and agitation 5.
• In terms of fast heart rate, also known as tachycardia, there is limited evidence to suggest that aripiprazole is a direct cause 3, 4.
• A case report published in 2020 found that a combination of lamotrigine, aripiprazole, and quetiapine can cause neuroleptic malignant syndrome, which can include symptoms such as tachycardia 6.
• Overall, while aripiprazole may not be a direct cause of fast heart rate, it is important to monitor patients taking this medication for any changes in heart rate or other cardiac symptoms 3, 4.

Cardiac Safety of Aripiprazole

• Aripiprazole has been found to have a low risk of cardiac arrhythmias and sudden cardiac death 4.
• A study published in 2015 found that aripiprazole decreases the mean ΔQTc interval, which suggests a low risk of QT prolongation 4.
• However, it is still important to monitor patients taking aripiprazole for any changes in heart rate or other cardiac symptoms, especially in patients with pre-existing cardiac conditions 3, 4.
• Other medications, such as metoprolol, have been found to be effective in treating supraventricular tachycardia, a type of fast heart rate 7.