A Case of Aripiprazole Induced Tardive Dyskinesia in a Neuroleptic-Naïve Patient with Two Years of Follow Up

Abstract

Tardive dyskinesia (TD) is arguably the most serious and potential irreversible side effect of antipsychotic medication. Traditionally first generation antipsychotics are the neuroleptics considered to have higher risk of TD as compared to second and third generation antipsychotics. Aripiprazole is a third-generation antipsychotic with a novel mechanism of action. Risk of developing TD with use of aripiprazole has been unknown. Recently many cases of aripiprazole associated TD have been reported. A case of 52 year old Caucasian woman is discussed who presented to us with first manic episode. Patient had never been treated with any antipsychotic medication in her life before. During current episode, she was treated with aripiprazole 30 mg/day. During follow up, patient was found to have developed dyskinetic oro-facial movements within 2 months of starting aripiprazole. She was not taking any other antipsychotic/anti-dopaminergic medication at that time. Patient's abnormal oro-facial movements could not be reversed in spite of immediate discontinuation of aripiprazole. Multiple medications are tried over the next 2 years but her movement disorder never remitted. Above case (along with other recent reports) suggest that risk of movement disorder with aripiprazole use could be higher than previously thought. Further studies are required to find out incidence of movement disorder with aripiprazole. Aripiprazole use should be preferably restricted to FDA approved indications. Clinician needs to be very vigilant about emergence of any movement disorder while using aripiprazole, especially in patients with risk factors for TD.

A Case of Aripiprazole-Induced Tardive Dyskinesia with Dramatic Evolution

“…Our case and its dramatic evolution, associated with other cases recently published (see, e.g., [11, 13–16]), incite reconsidering the real risk of tardive dyskinesia associated with aripiprazole. Finally, the use of aripiprazole for tardive dyskinesia improvement might not be a particularly safe care strategy given the specific risks of the molecule and the absence, so far, of long-term prospective studies [1].…”

Aripiprazole in Tardive Dyskinesia: Is it a Safe Choice?

“…[5,6] As aripiprazole has been reported to normalize dopamine D2 up-regulation, the antipsychotic may improve the symptoms of TD-induced by typical or atypical, antipsychotics. [7] Rapid dissociation of aripiprazole also appears to be responsible for its low potential to cause TD.…”

Tardive Dyskinesia Revisited-A Clinical Management Priority Perspective: A Voyage into High Dose Buspirone Part B

“…Aripiprazole doesn't. (Buspirone acts on D1, D2, D3, D4) [152][153][154][155][156] F. Common option which helps diagnosis because it worsens the TD.…”

“…However, there are often contradictions. It's interesting looking at the early work and predictions on TD [200,234,[238][239][240][241][242][243][244][245][246][247][248][249][250] compared with the most recent ideas [20,48,101,152,154,210,211,[216][217][218][219]. These latter ideas have taken into account clarity on genes and genetics of TD where at best the jury is undecided, and also still show contradictory data.…”