Aripiprazole and pathological gambling

Last edited 01/2024

Aripiprazole and risk of pathological gambling

Aripiprazole belongs to a class of medicines called antipsychotics

Aripiprazole has 3 approved indications:

• treatment of schizophrenia in adults and adolescents aged over 15 years;
• short-term treatment of moderate to severe manic episodes in Bipolar I Disorder in adults and adolescents aged 13 years and older;
• prevention of a new manic episode in adults who experienced predominantly manic episodes and whose manic episodes responded to aripiprazole treatment

A study comparing gambling behaviour in patients on ariprazole versus dopamine replacement therapy (DRT) showed (1):

• patients in the ariprazole group seemed to be more severe problem gamblers than patients in the DRT group
• note that:
  • gambling disorder is considered an adverse side effect of DRT gambling disorder (GD) is considered to be iatrogenic based on chronological and pharmacological arguments:
    • GD appeared after the onset of Parkinson's disease and DRT initiation and disappeared after discontinuing DRT

DRT acts dopamine receptors in the nigrostriatal pathway and in the reward pathway, which plays a role in addiction (1).

Aripiprazole is a partial D2 receptor agonist, whereas DRT includes full D2 receptor agonist (1)

The MHRA has received reports from stakeholders raising concerns about a lack of awareness of the association between aripiprazole and the development or worsening of addictive gambling behaviours (2).

Advice for healthcare professionals (2):

• there has been an increase in the number of Yellow Card reports of gambling disorder and pathological gambling associated with aripiprazole use; concerns have also been raised about a lack of awareness of this issue
• the UK reports occurred in patients with and without a prior history of gambling disorder and the majority were reported to resolve upon reduction of dose or stopping treatment with aripiprazole
• advise patients and their caregivers to be alert to the development of new or increased urges to gamble and other impulse control symptoms, such as excessive eating or spending, or an abnormally high sex drive
• consider dose reduction or stopping the medication if a patient develops these symptoms
• awareness of this risk must increase among patients and prescribers, as gambling is recognised as a common risk factor linked to suicide and is included within the suicide prevention in England: 5-year cross sector strategy
• report suspected adverse drug reactions associated with aripiprazole on a Yellow Card

Reference:

• Grall-Bronnec M, Sauvaget A, Perrouin F, Leboucher J, Etcheverrigaray F, Challet-Bouju G, Gaboriau L, Derkinderen P, Jolliet P, Victorri-Vigneau C. Pathological Gambling Associated With Aripiprazole or Dopamine Replacement Therapy: Do Patients Share the Same Features? A Review. J Clin Psychopharmacol. 2016 Feb;36(1):63-70
• Drug Safety Update volume 17, issue 5: December 2023: 1.