Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Wilson, M. S. Search for Related Content PubMed Citation Articles by Wilson, M. S., II Bipolar Disorder Atypical Neuroleptics

Aripiprazole and Bone Pain

TO THE EDITOR: Although numerous side effects are listed in the package insert for new medications, once a medication is available for clinical use in the general population, new side effects become known through trial and error. The following case illustrates an incidence of bone pain caused by aripiprazole on more than one occasion in the same patient.

Case Report

Ms. A was a 37-year-old single white woman who came in for an initial assessment at an outpatient residents clinic attached to a university hospital. Upon initial presentation, Ms. A was diagnosed with bipolar I disorder. She had been taking sertraline, 50 mg/day, as prescribed by her previous physician and was not taking any mood stabilizer. To better control her mixed state at presentation, Ms. A was started on aripiprazole, 7.5 mg, at night and maintained on sertraline. Ten days later, she returned to the clinic with significantly improved affective symptoms but complained of severe bone pain radiating down both legs. The bone pain was not associated with meals, physical activity, or time of day. At this point, aripiprazole was discontinued, and 7 days later, when she was seen again, Ms. A’s bone pain had completely remitted; this bone pain had not occurred before this event and did not return for the next year.

A year later, Ms. A elected to try taking aripiprazole again but at a much lower dose and a slow titration; she stated that despite the pain she had the year before, it was the best she had ever felt. The aripiprazole was reinitiated at 2.5 mg at night for 2 weeks. At this time, Ms. A was no longer taking sertraline and was taking 900 mg/day of oxcarbazepine, 200 mg/day of modafinil, 1680 mg/day of omega-3 fatty acids, and 150 mg/day of sustained-release bupropion. After 2 weeks, Ms. A was not complaining of any bone pain or other side effects, and her aripiprazole dose was titrated up to 5 mg/day. Seven days after starting the 5-mg dose, Ms. A began complaining again of bone pain in not only her legs but also her arms. At this point, it was decided to discontinue aripiprazole. Once again, the pain remitted within 7 days of discontinuation.

Discussion

The most recent package insert for aripiprazole does have bone pain listed; however, it states bone pain as "unlikely to be drug related" and "infrequent" (occurring in less than 1% but in more than 0.1% of all patients). Once a new medication is available to clinicians and no longer the sole domain of researchers, new information is often made available about both the beneficial and harmful effects not shown from the research literature. In time, we will find out more about what the effects of aripiprazole are.

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Wilson, M. S. Search for Related Content PubMed Citation Articles by Wilson, M. S., II Bipolar Disorder Atypical Neuroleptics

Get information about faster international access.

Privacy Policy

Copyright © 2005 Academy of Psychosomatic Medicine. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us