Reactions 1704, p50 - 2 Jun 2018 Various toxicities In a case series, a 13-year-old girl was described who experienced sleepiness (falling asleep early) and fatigue following treatment with aripiprazole and a 6.5-year-old girl was described who developed anxiety, agitation and aggression following treatment with aripiprazole and risperidone [routes and durations of treatments to reactions onsets not stated, not all dosages and outcomes stated]. Patient A: The 13-year-old girl, who had Pitt-Hopkins syndrome (PTHS), presented due to increased agitation, anxieties and behavioural changes. She started receiving aripiprazole 0.5 mg/day. Two weeks later, the dose was increased to 0.5mg twice daily. However, she started falling asleep early and also developed fatigue, hence, the dose was reduced to 0.4mg twice daily. A year later, her condition of falling asleep early still persisted. Patient B: The 6.5-year-old girl presented for sleeping problems, hyperactive behaviour, shouting and aggression. She started receiving risperidone, which was later increased to 0.25mg twice daily. Subsequently, she developed anxiety attacks in the form of fear. Consequently, a few weeks later, the dose was reduced to 0.1mg in morning and 0.15mg at night, which led to resolution of her fear. A few months later, the dose was gradually increased to 0.25mg twice daily. Consequently, she experienced paradoxical effect of anxiety attacks. A few weeks later, the dose was lowered to 0.25mg in morning and 0.2mg at night. At the age of eight years, a slow switch over to aripiprazole 1 mg/day was done wherein risperidone was continued at a low dose. Two and a half weeks later, a dose adjustment was done with risperidone (0.1mg in morning and 0.2mg at night) and aripiprazole 0.5mg twice daily. A month and half later, aripiprazole dose was increased to 1mg in morning and 0.5mg at night. At this increased dose, she developed temper tantrums and her agitation increased. Two months later, her risperidone dose was adjusted to 0.1mg in morning and 0.2mg at night, while the aripiprazole dose was adjusted to 0.6mg in morning and 0.5mg at night. Two weeks later, aripiprazole dose was increased to 0.7mg in morning and 0.5mg at night. A year and a half later, her shouting increased and she developed aggression. Hence, aripiprazole dose was reduced to 0.4mg twice daily and risperidone to 0.1mg twice daily, resulting in favourable behavioural effects. Author comment: "The risk of adverse effects, such as weight gain, drooling, somnolence, headaches, increased prolactin, and extrapyramidal symptoms, is real." "A mutation in the TCF4 gene could affect the dopamine system in children with PTHS, possibly leading to hypersensitivity to small dose changes of atypical antipsychotics." Lambrechts S, et al. Low-Dose Aripiprazole and Risperidone for Treating Problem Behavior in Children with Pitt-Hopkins Syndrome. Journal of Clinical Psychopharmacology 38: 260-261, No. 3, Jun 2018. Available from: URL: http:// doi.org/10.1097/JCP.0000000000000871 - Belgium 803323852 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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