Does Aripiprazole Increase Compulsive Urges to Use Substances? Case Reports and Literature Review

Abstract Purpose/Background Aripiprazole is commonly used to treat schizophrenia, bipolar disorder, and major depressive disorder and is preferred because of its relatively favorable side-effect profile. In 2016, the Food and Drug Administration released a warning regarding the risk of new impulse control problems with aripiprazole, including urges to gamble, binge eat, shop, and engage in sexual intercourse. These problems are rare but may cause significant harm if not recognized in time. Methods This report presents 2 clinical cases to hypothesize that aripiprazole may increase urges and compulsive use of substances in some patients with a history of substance use disorders. Results Both individuals had a previous history of substance use disorder before starting aripiprazole; they felt unable to stop using, as if compelled to use the substances while on aripiprazole, despite having good motivation to change. They reported a decreased urge to use substances after discontinuation of aripiprazole and were able to abstain from substances for sustained periods. Implications/Conclusions These case reports suggest that aripiprazole may increase urges and compulsive substance use in patients with a history of substance use disorders. The findings emphasize the importance of a thorough preprescription assessment, education, informed consent, and regular monitoring of patients prescribed aripiprazole for increased urges or compulsions to use substances, in addition to other impulsive-compulsive behaviors. Further research is needed to confirm the association.