Withdrawal seizure associated with high dosage of aripiprazole and fluoxetine: a case report

Abstract

Aripiprazole, a third-generation antipsychotic, has been considered to have a high safety profile and rare withdrawal symptoms. We reported the case of a schizophrenic patient with a significant obsession, who was treated with a high dosage of aripiprazole and fluoxetine. Generalized tonic-clonic seizure occurred two days after abruptly stopping these two medications. Gradually tapering aripiprazole is suggested in clinical practice, especially when using a high dosage.

Share and Cite:

Su, J. , Chou, S. , Tsai, C. and Hung, T. (2011) Withdrawal seizure associated with high dosage of aripiprazole and fluoxetine: a case report. Open Journal of Psychiatry, 1, 30-32. doi: 10.4236/ojpsych.2011.12005.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Burris K.D., Molski, T.F., Xu, C., Ryan, E, Tottori, K., Kikuchi, T., Yocca, F.D. and Molinoff, P.B. (2002) Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors. The Journal of Pharmacology and Experimental Therapeutics, 302, 381-389. doi:10.1124/jpet.102.033175
[2] Naber, D. and Lambert, M. (2004) Aripiprazole: A new atypical antipsychotic with a different pharmacological mechanism. Progress in Neuropsychopharmacology & Biological Psychiatry, 28, 1213-1219. doi:10.1016/j.pnpbp.2004.06.020
[3] Potkin, S.G., Saha, A.R., Kujawa, M.J., Carson, W.H., Ali, M., Stock, E., Stringfellow, J., Ingenito, G. and Marder, S.R. (2003) Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs. placebo in patients with schizophrenia and schizoaffective disorder. Archives of General Psychiatry, 60, 681-690. doi:10.1001/archpsyc.60.7.681
[4] Keck, P.E., Orsulak, P.J., Cutler, A.J., Sanchez, R., Torbeyns, A., Marcus, R.N., McQuade, R.D. and Carson, W.H. (2009) Aripiprazole monotherapy in the treatment of acute bipolar I mania: A randomized, double-blind, placebo- and lithium-controlled study. Journal of Affective Disorders, 112, 36-49. doi:10.4088/JCP.v66n1002
[5] Simon, J.S. and Nemeroff, C.B. (2005) Aripiprazole augmentation of antidepressants for the treatment of partially responding and nonresponding patients with major depressive disorder. The Journal of Clinical Psychiatry, 66, 1216-1220. doi:10.4088/JCP.v66n1002
[6] Yang, K.C., Su, T.P. and Chou, Y.H. (2008) Effectiveness of aripiprazole in treating obsessive compulsive symptoms. Progress in Neuropsychopharmacology & Biological Psychiatry, 32, 585-586. doi:10.1016/j.pnpbp.2007.10.009
[7] Sarkar, R., Klein, J. and Kruger, S. (2008) Aripiprazole augmentation in treatment-refractory obssive-compulsive disorder. Psychopharmacology, 197, 687-688. doi:10.1007/s00213-008-1091-1
[8] DeLeon, A., Patel, N.C. and Crismon, M.L. (2004) Aripi- prazole: A comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clinical Therapeutics, 26, 649-666. doi:10.1016/S0149-2918(04)90066-5
[9] Abilfy/aripiprazole (2004) Bristol-Meyers Squibb Company/Otsuka American Pharmaceutical Inc., New York.
[10] Tsai, J.F. (2006) Aripiprazole-associated seizure. The Journal of Clinical Psychiatry, 67, 995-996. doi:10.4088/JCP.v67n0619b
[11] Malik, A.R. and Ravasia, S. (2005) Aripiprazole-induced seizure. Canadian Journal of Psychiatry, 50, 186.
[12] Stahl, M.S. (2008) Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 3rd edition, Cambridge University Press, Cambridge.
[13] Alldredge, B.K. (1999) Seizure risk associated with psychotropic drugs: Clinical and pharmacokinetic considerations. Neurology, 53, S68-75.
[14] Dailey, J.W., Yan, Q.S., Mishra, P.K., Burger, R.L. and Jobe, P.C. (1992) Effects of fluoxetine on convulsions and on brain serotonin as detected by microdialysis in genetically epilepsy-prone rats. The Journal of Pharmacology and Experimental Therapeutics, 260, 533-540.
[15] Stahl, M.M., Lindquist, M, Pettersson, M., Edwards, I.R., Sanderson, J.H., Taylor, N.F., Fletcher, A.P. and Schou, J.S. (1997) Withdrawal reactions with selective serotonin re-uptake inhibitors as reported to the WHO system. European Journal of Clinical Pharmacology, 53, 163-169. doi:10.1007/s002280050357
[16] Cassano, G.B., Fagiolini, A., Lattanzi, L., Monteleone, P., Niolu, C., Sacchetti, E., Siracusano, A. and Vita, A. (2007) Aripiprazole in the treatment of schizophrenia: A consensus report produced by schizophrenia experts in Italy. Clinical Drug Investigation, 27, 1-13. doi:10.2165/00044011-200727010-00001
[17] Duggal, H.S. and Mendhekar, D.N. (2006) High-dose aripiprazole in treatment-resistant schizophrenia. The Journal of Clinical Psychiatry, 67, 674-675. doi:10.4088/JCP.v67n0420c
[18] Gupta, S., Chohan, M. and Madhusoodanan, S. (2004) Treatment of acute mania with aripiprazole in an older adult with noted improvement in coexisting parkinson’s disease. Primary Care Companion to the Journal of Clinical Psychiatry, 6, 50-51. doi:10.1345/aph.1H240
[19] Chavez, B. and Poveda, R.A. (2006) Efficacy with high-dose aripiprazole after olanzapine-related metabolic disturbances. The Annals of Pharmacotherapy, 40, 2265- 2268. doi:10.1345/aph.1H240
[20] Preskorn, S.H. (2003) Relating clinical trials to psychiatric practice: Part I: The case of a 13-year old on aripiprazole and fluoxetine. Journal of Psychiatric Practice, 9, 307-313. doi:10.1097/00131746-200307000-00006
[21] Woolley, J. and Smith, S. (2001) Lowered seizure threshold on olanzapine. The British Journal of Psychiatry, 178, 85-86. doi:10.1192/bjp.178.1.85-a
[22] Beasley, C.M.Jr., Tollefson, G., Tran, P., Satterlee, W., Sanger, T. and Hamilton S. (1996) Olanzapine versus placebo and haloperidol: Acute phase results of the North American double-blind olanzapine trial. Neuropsychopharmacology, 14, 111-123. doi:10.1016/0893-133X(95)00069-P

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.