Aripiprazole in Children and Adolescents

Abstract

Objective: To review the use of aripiprazole in children and adolescents. Methods: Medline and Embase databases were systematically searched using the keywords aripiprazole and child or adolescent over the period from 2000 to 2019. The initial screen yielded 163 publications, from which 99 studies were reviewed. Results: Aripiprazole is one of the most widely prescribed atypical antipsychotics. Like others, its use in children and adolescents is becoming commonplace and occurs in off-label indications. Aripiprazole has proven efficacy for several indications in children and adolescents, including schizophrenia, bipolar disorder, Tourette's syndrome, and behavioral impairments associated with autism and intellectual disability. Adverse effects are more important in children and adolescents than adults, particularly weight gain, drowsiness, extrapyramidal effects, and metabolic effects, even though the latter may appear less important than with other atypical antipsychotics. Severe adverse effects often occur in multiple-prescription settings. At present, postprescription monitoring is very poor. Conclusion: Aripiprazole has proven efficacy for several indications in children and adolescents. However, its use requires clinical and paraclinical monitoring to assess the occurrence of adverse events that may challenge the benefit/risk ratio. In addition, off-label prescriptions should be limited, as they appear to account for a significant proportion of aripiprazole use worldwide.

We Really Need Clear Guidelines and Recommendations for Safer and Proper Use of Aripiprazole and Risperidone in a Pediatric Population: Real-World Analysis of EudraVigilance Database

“…Using the classification of SOCs, we found that psychiatric reactions and reproductive system and breast disorders were the most frequently reported AEs for aripiprazole and risperidone, respectively. These results are similar to those of Jakobsen KD and collaborators; they analyzed ADRs concerning aripiprazole-associated neurological and psychiatric events in children and adolescents through the database of the Danish Medicines Agency and observed that, in patients with psychotic disorders, aripiprazole could lead to aggressive behavior, anxiety, hallucinations, mental tics, neuroleptic malignant syndrome, overeating, and suicidal behavior (34,35). Our findings also reveal that aggression was one of the most frequently reported psychiatric aripiprazoleinduced event; moreover, we observed several ICSRs of suicidal behavior, such as completed suicide, suicide attempt/ideation, and intentional self-injury; these accounted for a total of 90 AEs.…”

Aripiprazole in young people with early psychosis: a systematic review and meta-analysis of weight gain

“…4,5 Early studies concluded that aripiprazole had relatively neutral effects on weight when compared to other antipsychotics, 6,7 while other studies have yielded opposite findings. [8][9][10][11][12] It has been suggested that young people may be at higher risk because of the interaction of psychotropic medication and pubertal maturation. 13 The most recent systematic reviews on the topic of aripiprazole-induced weight gain in young people (pub-lished in 2011 5,14 and 2013 15 ) concluded that there was insufficient evidence for definitive conclusions especially given the small number of studies conducted in Aripiprazole in young people with early psychosis: a systematic review and meta-analysis of weight gain…”

“Polypharmacy in neuroleptics side‐effects comparison: a bias not to be overlooked”

“…The intake of multiple neuroleptics can lead to dose‐dependent increases of antipsychotic side‐effects (Fleischhacker & Uchida, 2014), where metabolic parameters (Gallego et al, 2012) and, specifically, weight gain (Suzuki et al, 2008) are included. Moreover, polyprescriptions have been associated with the most serious drug‐induced secondary effects (Coustals et al, 2020). Nonetheless, polypharmacotherapy and drug interactions in psychiatry are considered to be commonly overlooked (Ordak & Nasierowski, 2019), understudied and in need for further research (Fleischhacker & Uchida, 2014; Gallego et al, 2012; Suzuki et al, 2008).…”

“…The results of this work are surely curious, as aripiprazole is commonly viewed as one of the preferred and least harmful neuroleptics regarding metabolic side‐effects, while paliperidone has been shown to cause a statistically significant higher weight gain than aripiprazole (Huhn et al, 2019; Leucht et al, 2014). It is known that nearly all second‐generation antipsychotics are considered to cause weight gain among young populations (Schimmelmann et al, 2013), aripiprazole included (Coustals et al, 2020; Schimmelmann et al, 2013). However, the latter has been ranked among the ones associated with the lowest weight gain in short‐term controlled‐trials in young individuals (de Hert et al, 2011) and a recent review of its use in children and adolescents has found that although aripiprazole carries more important weight gain in this population than in adults, these effects appear to be less pronounced than with other atypical neuroleptics (Coustals et al, 2020).…”

“…It is known that nearly all second‐generation antipsychotics are considered to cause weight gain among young populations (Schimmelmann et al, 2013), aripiprazole included (Coustals et al, 2020; Schimmelmann et al, 2013). However, the latter has been ranked among the ones associated with the lowest weight gain in short‐term controlled‐trials in young individuals (de Hert et al, 2011) and a recent review of its use in children and adolescents has found that although aripiprazole carries more important weight gain in this population than in adults, these effects appear to be less pronounced than with other atypical neuroleptics (Coustals et al, 2020). Aripiprazole has also been successfully used as a key switching antipsychotic to ameliorate metabolic side‐effects (Stroup et al, 2011).…”