What is the frequency of impulsive behavior associated with Aripiprazole (Abilify) at various dosages?

From the Guidelines

Impulsive behavior is a rare but serious side effect of Abilify (aripiprazole), occurring in approximately 1-2% of patients, with higher doses (15-30 mg daily) associated with greater risk than lower doses (2-10 mg daily) 1. The risk of impulsive behavior with Abilify appears to be dose-dependent, with higher doses generally associated with greater risk than lower doses.

• The exact incidence of impulsive behavior with Abilify is not well-established, but it is considered a rare side effect, occurring in approximately 1-2% of patients.
• The risk of impulsive behavior with Abilify may be higher in patients with a personal or family history of impulse control disorders, substance use disorders, or bipolar disorder.
• Patients should be monitored for new or worsening impulsive behaviors at all doses, but particularly when dosages exceed 15 mg daily.
• If impulsive behaviors develop, dose reduction or medication discontinuation should be considered in consultation with a healthcare provider, as these impulse control disorders are thought to be related to Abilify's partial agonist activity at dopamine receptors, particularly in the brain's reward pathways 1. The medication's unique mechanism of action can sometimes overstimulate these pathways in susceptible individuals, leading to impulsive behaviors such as compulsive gambling, shopping, eating, or sexual behavior.
• A case series illustrates the potential use of aripiprazole in the treatment of nightmares in conjunction with sertraline and/or cognitive-behavioral psychotherapy in the management of PTSD, with dosages ranging from 15-30 mg/day 1.

From the FDA Drug Label

Post-marketing case reports suggest that patients can experience intense urges, particularly for gambling, and the inability to control these urges while taking aripiprazole. Other compulsive urges, reported less frequently, include: sexual urges, shopping, eating or binge eating, and other impulsive or compulsive behaviors Because patients may not recognize these behaviors as abnormal, it is important for prescribers to ask patients or their caregivers specifically about the development of new or intense gambling urges, compulsive sexual urges, compulsive shopping, binge or compulsive eating, or other urges while being treated with aripiprazole It should be noted that impulse-control symptoms can be associated with the underlying disorder. In some cases, although not all, urges were reported to have stopped when the dose was reduced or the medication was discontinued.

The frequency of impulsive behavior on Abilify (aripiprazole) is not explicitly stated in the provided drug label. However, it is mentioned that post-marketing case reports suggest that patients can experience intense urges, including impulsive or compulsive behaviors.

• The dose at which impulsive behavior occurs is not specified, but it is noted that in some cases, urges were reported to have stopped when the dose was reduced or the medication was discontinued 2.
• It is recommended that prescribers ask patients or their caregivers about the development of new or intense urges while being treated with aripiprazole.
• Impulse-control symptoms can be associated with the underlying disorder, and compulsive behaviors may result in harm to the patient and others if not recognized.
• Consider dose reduction or stopping the medication if a patient develops such urges.

From the Research

Impulsive Behavior on Abilify

• Impulsive behavior, including problem gambling, hypersexuality, obsessive-compulsive symptoms, and other impulsive and/or compulsive behaviors, has been reported in patients taking aripiprazole (Abilify) 3.
• The majority of cases (71.18%) were male, with a mean age of 33.83 years, and the average daily dose of aripiprazole was 11.63 mg 3.
• The most frequently published impulsivity adverse effect of aripiprazole is gambling, followed by hypersexuality, obsessive-compulsive symptoms/disorder, problem eating, trichotillomania, problem shopping, and kleptomania 3.
• These symptoms were experienced both by patients who had previous problems in these areas and those who did not, and they often appeared within 30 days after aripiprazole administration started and ceased within 30 days of its discontinuation and/or dose decrease 3.

Dose-Related Information

• The average daily dose of aripiprazole associated with impulsive behavior was 11.63 mg, with a range of doses likely contributing to the development of these symptoms 3.
• The recommended starting and target dose for aripiprazole is 10 or 15 mg/day, and dosage increases should not be made before 2 weeks of continuous therapy 4.
• Aripiprazole has been systematically evaluated and shown to be effective in a dose range of 10 to 30 mg/day 4.

Special Considerations

• Clinicians should be aware of impulsivity adverse effects, monitor them, and educate both patients and their families about them 3.
• Aripiprazole may increase urges and compulsive substance use in patients with a history of substance use disorders, emphasizing the importance of thorough preprescription assessment, education, informed consent, and regular monitoring 5.