Photosensitivity Risk with Brexpiprazole and Aripiprazole
Neither brexpiprazole nor aripiprazole (Abilify) are commonly associated with significant photosensitivity reactions, but aripiprazole has documented photosensitivity as a potential side effect in its FDA labeling.
FDA Labeling Evidence for Photosensitivity
Aripiprazole (Abilify)
The FDA drug labeling for aripiprazole specifically lists photosensitivity reactions as a potential side effect:
- Listed under "Skin and Subcutaneous Tissue Disorders" as an infrequent adverse reaction: "photosensitivity reaction" 1
- This places photosensitivity in the "infrequent" category of side effects, meaning it's not common but has been documented
Brexpiprazole
- No specific mention of photosensitivity reactions in available evidence
Clinical Implications and Management
Risk Assessment
- Photosensitivity with aripiprazole appears to be an infrequent reaction
- The risk is lower than with other psychiatric medications known to cause significant photosensitivity, such as:
- Chlorpromazine and thioridazine (phenothiazine antipsychotics) which are among the most commonly implicated medications for photosensitivity 2
Monitoring and Prevention
If using aripiprazole:
- Inform patients about the possibility of increased sun sensitivity
- Recommend standard sun protective measures:
- Avoiding sun exposure during peak hours (10 AM - 4 PM)
- Using broad-spectrum sunscreen with SPF 30+
- Wearing protective clothing, wide-brimmed hats, and UV-blocking sunglasses
Signs of Photosensitivity to Watch For
- Exaggerated sunburn-like reaction in sun-exposed areas
- Skin eruptions limited to or accentuated in light-exposed areas
- Reactions may present with various morphologies:
- Sunburn-like responses
- Eczematous or lichenoid lesions
- In rare cases, bullous lesions 3
Management if Photosensitivity Occurs
- Consider discontinuation of aripiprazole if reaction is severe
- Treat eruptions with potent topical corticosteroids
- Consider switching to brexpiprazole which does not have documented photosensitivity reactions
Practical Considerations
Medication Choice
- If a patient has a history of photosensitivity reactions or significant sun exposure is anticipated, brexpiprazole may be preferred over aripiprazole
- For patients already stable on aripiprazole without photosensitivity issues, switching is unnecessary
Patient Education
- Emphasize that photosensitivity with aripiprazole is infrequent but possible
- Explain that photosensitivity reactions can occur even with brief sun exposure
- Stress the importance of preventive measures rather than medication discontinuation
Conclusion
While both medications appear to have low risk of photosensitivity, aripiprazole has documented cases of photosensitivity reactions in its FDA labeling, whereas brexpiprazole does not have this specific warning in the available evidence. Proper sun protection measures should be advised for patients taking either medication, with particular attention for those on aripiprazole.