Can Aripiprazole (Abilify) cause rhabdomyolysis?

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.

• Rhabdomyolysis is not explicitly mentioned in the drug label as an adverse reaction associated with aripiprazole overdosage.
• However, blood creatine phosphokinase increased is mentioned, which can be a sign of rhabdomyolysis.
• Given the information available, it is unclear if aripiprazole can cause rhabdomyolysis, but an increase in creatine phosphokinase, a potential indicator of rhabdomyolysis, has been observed in some cases of aripiprazole overdose 1.

From the Research

Yes, Abilify (aripiprazole) can cause rhabdomyolysis, though it is a rare side effect. Rhabdomyolysis is a serious condition involving the breakdown of muscle tissue that releases proteins like myoglobin into the bloodstream, which can damage the kidneys. Patients taking Abilify should be aware of symptoms such as muscle pain, weakness, tenderness, dark urine, decreased urination, fatigue, and irregular heartbeat. This side effect appears to be more common when starting treatment or increasing the dose, and may be related to Abilify's effects on dopamine receptors or potential interactions with other medications.

Key Points to Consider

• Risk factors include high doses, rapid dose increases, combining with other medications that affect muscle tissue, dehydration, and strenuous exercise.
• If symptoms develop, patients should seek immediate medical attention as rhabdomyolysis requires prompt treatment to prevent kidney damage.
• Regular monitoring by healthcare providers, especially during dose adjustments, is important for those taking Abilify. According to a recent case report 2, a 17-year-old male patient developed rhabdomyolysis after taking 2.5 mg/day of aripiprazole for 13 days, highlighting the importance of monitoring patients, especially during the initial treatment phase. Another study 3 found that rhabdomyolysis was reported more frequently with olanzapine relative to all reports for children and adolescents with antipsychotic medicines, but also mentioned aripiprazole as a suspected antipsychotic medicine.

Monitoring and Prevention

• Patients taking Abilify should be monitored for symptoms of rhabdomyolysis, especially during dose adjustments or when starting treatment.
• Healthcare providers should be aware of the potential risk of rhabdomyolysis associated with Abilify and take necessary precautions to prevent and treat it promptly. A study 4 compared the risks of acute kidney injury (AKI) associated with various antipsychotics, including aripiprazole, and found that while aripiprazole had an insignificantly higher risk of AKI compared to haloperidol, the overall incidence of AKI was moderate. However, this study did not specifically focus on rhabdomyolysis, but rather on AKI, which can be a consequence of rhabdomyolysis.

Clinical Implications

• Clinicians should be aware of the potential risk of rhabdomyolysis associated with Abilify and take necessary precautions to prevent and treat it promptly.
• Patients should be educated on the symptoms of rhabdomyolysis and the importance of seeking immediate medical attention if they develop. Overall, while the risk of rhabdomyolysis associated with Abilify is rare, it is a serious side effect that requires prompt attention and treatment to prevent kidney damage. Regular monitoring and education of patients are crucial in preventing and managing this condition.