What are the management options for pruritus (itching) associated with Abilify (aripiprazole)?

Management of Pruritus Associated with Abilify (Aripiprazole)

For pruritus associated with Abilify (aripiprazole), the recommended first-line approach is to continue the medication while initiating topical moderate to high-potency corticosteroids, with oral antihistamines as adjunctive therapy. 1

Initial Management Approach

First-line interventions:

• Continue aripiprazole at current dose while monitoring for changes in severity 1
• Apply topical moderate to high-potency corticosteroids such as mometasone furoate 0.1% or betamethasone valerate 0.1% ointment 1, 2
• Add non-sedating oral antihistamines for daytime use (fexofenadine 180mg or loratadine 10mg) 1, 2
• Consider mildly sedating antihistamines (cetirizine 10mg) for nighttime pruritus 1, 2

For mild or localized pruritus:

• Apply topical corticosteroids to affected areas once or twice daily 1
• Use solutions or foams for scalp application as they penetrate better than creams or ointments 2
• Use low-potency hydrocortisone for facial areas to avoid skin atrophy 2

Management of Persistent Pruritus

If symptoms persist after 2 weeks of initial therapy, consider:

1. GABA agonists as second-line therapy:

   • Pregabalin (25-150 mg daily) or
   • Gabapentin (900-3600 mg daily) 1, 2

2. Alternative medications:

   • Mirtazapine (30 mg daily) 1, 2
   • Selective serotonin reuptake inhibitors (paroxetine, fluvoxamine) 1, 2
   • Consider combination of H1 and H2 antagonists (e.g., fexofenadine and cimetidine) 1

Severe or Intolerable Pruritus

For Grade 3 (severe) or intolerable Grade 2 pruritus:

• Interrupt aripiprazole treatment until symptoms improve to Grade 0-1 1
• Continue treatment with topical corticosteroids, antihistamines, and GABA agonists 1
• Consider dermatology consultation for possible skin biopsy and further evaluation 2
• If symptoms persist despite treatment interruption, discontinuation of aripiprazole may be necessary 1

Important Considerations

Monitoring and Follow-up

• Reassess after 2 weeks of treatment 1, 2
• If improved, continue treatment until resolution, then taper as clinically feasible
• If no improvement or worsening, escalate therapy or refer to dermatology

Cautions

• Aripiprazole has been reported to cause severe cutaneous reactions in rare cases, including lichenoid drug reactions 3, 4
• These reactions may require medical and surgical intervention 3
• Be vigilant for signs of extensive skin involvement that might indicate a more serious reaction

Patient Education

• Regular application of emollients to prevent skin dryness 2
• Avoid frequent bathing and harsh soaps that can exacerbate dryness 2
• Implement relaxation techniques to reduce stress-induced pruritus 2

Special Populations

Elderly Patients

• Avoid sedative antihistamines due to increased risk of adverse effects 2
• Use high lipid content moisturizers 2
• Consider lower starting doses of systemic medications like gabapentin 2

This approach aligns with current guidelines for managing drug-induced pruritus while balancing the need to maintain antipsychotic therapy when possible. The decision to continue, interrupt, or discontinue aripiprazole should be based on the severity of pruritus and its impact on the patient's quality of life.