Can Abilify Cause Tinnitus?
Yes, Abilify (aripiprazole) can cause tinnitus as an adverse effect, though paradoxically it has also been reported to treat certain auditory abnormal sensations in select cases.
Evidence for Aripiprazole-Induced Tinnitus
The relationship between aripiprazole and tinnitus is complex and bidirectional:
NSAIDs and central nervous system effects: While the evidence specifically linking aripiprazole to tinnitus is limited in the provided guidelines, tinnitus is recognized as a reversible central nervous system adverse effect of various medications and may be a sign of high medication blood levels 1.
Large-scale adverse event data: A comprehensive analysis of the FDA Adverse Event Reporting System database (2012-2023) identified drug-related tinnitus across multiple medication classes, with duloxetine, ciprofloxacin, and adalimumab showing the strongest associations 2. While aripiprazole was not among the top 25 drugs, this does not exclude its potential to cause tinnitus in susceptible individuals 2.
Common side effects profile: Aripiprazole's known side effects include headache, agitation, anxiety, insomnia, dizziness, and drowsiness 3. These neurological effects suggest potential for auditory symptoms in the broader context of central nervous system effects.
Paradoxical Therapeutic Use
Interestingly, aripiprazole has demonstrated efficacy in treating auditory abnormal sensations in specific clinical scenarios:
Case reports of benefit: Two recent cases showed marked improvement in auditory symptoms (including tinnitus, aural fullness, and pseudo-hallucinations) with aripiprazole when traditional approaches failed 4.
Dopaminergic pathway modulation: The dopaminergic pathway shares cerebral structures with tinnitus perception (prefrontal, temporal, temporo-parietal areas, and limbic system), and dopamine modulation through aripiprazole may reduce tinnitus perception in select patients 5.
Clinical Context in Psychiatric Patients
For your adult patient with psychiatric conditions:
Psychiatric comorbidity is common: Tinnitus frequently coexists with psychiatric disorders, and patients with psychotic disturbances can develop tinnitus phenomena that require differentiated treatment from the underlying psychiatric condition 6.
Bidirectional relationship: Patients with tinnitus accompanied by severe anxiety or depression require prompt identification and intervention, as suicide has been reported in patients with tinnitus who have coexisting psychiatric illness 1.
Treatment considerations: Some psychotropic drugs may diminish tinnitus through improving general psychiatric comfort and direct central influence 7.
Clinical Approach
If your patient develops new-onset tinnitus while on aripiprazole:
Evaluate timing: Determine if tinnitus onset correlates with aripiprazole initiation or dose escalation, as tinnitus can be reversible and may indicate high medication blood levels 1.
Assess severity and impact: Document whether the tinnitus is persistent, bothersome, and affecting quality of life, as these factors determine the need for intervention 1.
Rule out other causes: Conduct thorough clinical evaluation to identify potentially treatable causes of secondary tinnitus (Menière's disease, sudden sensorineural hearing loss, otosclerosis) before attributing symptoms solely to medication 1.
Consider audiologic evaluation: Most tinnitus occurs with concomitant sensorineural hearing loss, particularly in patients with bothersome tinnitus and no obvious ear pathology 1.
Weigh risk-benefit: If aripiprazole is effectively managing the psychiatric condition and tinnitus is mild, continuation with supportive tinnitus management (sound therapy, counseling) may be appropriate 1. If tinnitus is severe and distressing, consider alternative antipsychotics with lower sedation profiles like quetiapine or olanzapine, though these have different side effect profiles 8.
Critical Pitfall to Avoid
Do not automatically discontinue aripiprazole without assessing the clinical necessity and risk-benefit ratio 9. The psychiatric stability achieved with aripiprazole must be weighed against the severity of tinnitus symptoms, as abrupt discontinuation could precipitate psychiatric decompensation in a vulnerable patient.