Monday Pharmaceutical Mystery: March 25

JB's husband has been noticing out of character behavior. Could it be 1 of her medications?

JB is a female patient, aged 28 years, at your pharmacy. Her husband comes into the pharmacy one day, shyly asking to speak with the pharmacist. “I know this sounds crazy,” he says, “but JB has not been herself lately. Could it be any of her medications?”

Upon further questioning, JB’s husband shares that she has been racking up enormous credit card bills for the last few months. This is not like JB at all, who usually sticks to a carefully planned budget. He happens to mention that JB has also taken several trips to the casino with her friends, which is also completely out of character for her.

Medication List:

  • Lo Loestrin Fe: 1 tablet by mouth daily
  • Atorvastatin 10 mg: 1 tablet by mouth daily
  • Escitalopram 20 mg: 1 tablet by mouth daily
  • Aripiprazole 10 mg: 1 tablet by mouth daily
  • Ventolin HFA: 2 puffs by mouth every 4-6 hours as needed for wheezing
  • Naproxen 500 mg EC: 1 tablet by mouth twice daily as needed for pain/inflammation

Mystery: What is causing this compulsive, out of character behavior? Could one of JB’s medications be the culprit?

Solution: Aripiprazole (Abilify, Otsuka) may very well be to blame. The FDA warns that “compulsive or uncontrollable urges to gamble, binge eat, shop, and have sex have been reported with the use of the antipsychotic drug aripiprazole.” These impulse-control issues, while rare, could result in harm to the patient if not recognized. The urges stop after the medication is stopped or the dose is decreased.

The pharmacist/JB should immediately contact the prescribing physician and discuss the next steps, which most likely will involve a decrease in dose or a slow taper to discontinuation of aripiprazole. This occurrence should also be reported to the FDA MedWatch program.

Reference

FDA Drug Safety Communication: FDA warns about new impulse-control problems associated with mental health drug aripiprazole (Abilify, Abilify Maintena, Aristada). FDA website. https://www.fda.gov/drugs/drugsafety/ucm498662.htm. Updated June 7, 2016. Accessed March 21, 2019