Can Aripiprazole (Abilify) cause dizziness and unsteady gait?

Aripiprazole and Its Association with Dizziness and Unsteady Gait

Yes, aripiprazole (Abilify) can definitely cause dizziness and unsteady gait as documented side effects. 1, 2

Mechanism and Prevalence

• Aripiprazole is a third-generation atypical antipsychotic that works as a partial agonist at dopamine D2 receptors and serotonin 5-HT1A receptors, while acting as an antagonist at serotonin 5-HT2A receptors 3, 4
• Dizziness is specifically listed as a common adverse effect in the FDA drug label, occurring in approximately 10% of adult patients taking aripiprazole compared to 7% on placebo 2
• In pediatric patients (6-18 years), dizziness occurs in approximately 3% of those taking aripiprazole compared to 2% on placebo 2

Clinical Presentation

• Dizziness may be related to orthostatic hypotension, which is also a documented side effect of aripiprazole 2
• The FDA label specifically warns that "aripiprazole may cause orthostatic hypotension, perhaps due to its α1-adrenergic receptor antagonism" 2
• These symptoms can manifest as:
  • Postural dizziness (0.5% in aripiprazole vs. 0.3% in placebo) 2
  • Syncope (0.5% in aripiprazole vs. 0.4% in placebo) 2
  • Unsteady gait or falls due to motor and sensory instability 2

Risk Factors

• Risk factors for increased susceptibility to dizziness and unsteady gait with aripiprazole include:
  • Older age (reduced dosing is recommended in elderly patients) 1
  • Poor metabolizers of cytochrome P450 2D6 1, 5
  • Patients with known cardiovascular disease 2
  • Patients with cerebrovascular disease 2
  • Conditions predisposing to hypotension (dehydration, hypovolemia) 2
  • Concurrent treatment with antihypertensive medications 2

Clinical Management

• The FDA label specifically includes a warning about falls: "Antipsychotics, including aripiprazole, may cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries" 2
• Management recommendations include:
  • Consider dose reduction if dizziness or unsteady gait occurs 1
  • Complete fall risk assessments when initiating treatment and recurrently for patients on long-term therapy 2
  • Use lower doses in older or frail patients 1
  • Monitor for orthostatic changes in blood pressure 2
  • Use caution in patients with conditions that could exacerbate these effects 2

Additional Considerations

• Dizziness may also occur with other medications in the same class, but aripiprazole has a unique receptor binding profile that may influence its side effect profile 3, 4
• While aripiprazole generally has a lower propensity for causing extrapyramidal side effects than typical antipsychotics, movement disorders including dizziness and unsteady gait remain important potential adverse effects to monitor 4, 6
• In rare cases, more severe movement disorders like oculogyric crisis have been reported, which can be associated with dizziness 6

Clinicians should be vigilant about monitoring for these side effects, particularly when initiating treatment or adjusting dosages, and should consider dose reduction or medication change if significant dizziness or unsteady gait occurs 1, 2.