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- W2123286568 abstract "Back to table of contents Previous article Next article LettersFull AccessReversal of Aripiprazole-Induced Tardive Akathisia by Addition of PregabalinDomenico De Berardis, M.D., Ph.D., Nicola Serroni, M.D., Francesco Saverio Moschetta, M.D., Giovanni Martinotti, M.D., Ph.D., and Massimo Di Giannantonio, M.D.Domenico De BerardisSearch for more papers by this author, M.D., Ph.D., Nicola SerroniSearch for more papers by this author, M.D., Francesco Saverio MoschettaSearch for more papers by this author, M.D., Giovanni MartinottiSearch for more papers by this author, M.D., Ph.D., and Massimo Di GiannantonioSearch for more papers by this author, M.D.Published Online:1 Apr 2013https://doi.org/10.1176/appi.neuropsych.12030069AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Akathisia, as adverse effect of aripiprazole, has been reported in literature and may be particularly distressing for the patients. We report a case of aripiprazole-induced tardive akathisia that resolved after introduction of pregabalin.Aripiprazole is an antipsychotic drug with a unique pharmacological profile, particularly as a partial agonist to dopamine D2 receptors, but akathisia, as adverse effect, has been reported in literature and may be particularly distressing for patients.1 We report a case of aripiprazole-induced tardive akathisia that resolved after introduction of pregabalin.The patient was a 42-year-old housewife with a DSM-IV diagnosis of bipolar disorder (BD). She was previously treated with risperidone and olanzapine without improvement and was developing EPS and weight gain. She came voluntarily to our observation at our outpatient facility in February 2011, referred by her family physician. She was taking aripiprazole 15 mg/day for approximately 8 months with complete remission. However, she complained of subjective restlessness with a constant wish to move about. The restlessness was worse at rest and was calmed by moving her legs while sitting or by walking. She was unable to sit still in one place and would constantly move her legs or walk about. The score on Barnes Akathisia Rating Scale (BARS) was 5 (severe akathisia).She refused to stop aripiprazole because of subjective efficacy on her symptoms and lack of effects on body weight and shape. Therefore, pregabalin 150 mg/day was given in addition to aripiprazole monotherapy. Before starting the pharmacological treatment, a complete physical, instrumental, and laboratory screening (including brain MRI) was carried out and resulted negative.After 2 weeks of pregabalin addition, we observed an improvement of akathisia (BARS: 2), without adverse effects related to pregabalin. At the end of the third week of combined therapy, the subjective and objective signs of akathisia subsided, and the score on the BARS fell to 0. The last observation was made in March 2012; the patient was taking aripiprazole 15 mg/day and pregabalin 150 mg/day, with absence of akathisia. The patient provided informed consent to present this report.To our knowledge, this was the first observation that reported a positive effect of pregabalin on aripiprazole-induced akathisia. As pregabalin binds to the alpha-2-delta subunit of the presynaptic neuron's voltage-gated calcium channels (VGCCs), such binding reduces calcium influx, consequently decreasing neuronal hyperexcitability.2 Therefore, pregabalin reduces the release of several neurotransmitters, including glutamate, norepinephrine, serotonin, and dopamine, 3,4 and this may explain the efficacy of pregabalin on akathisia. Moreover, as a high 5-HT2A:D2 occupancy ratio may ameliorate drug-induced akathisia,5 it is possible that pregabalin may act to restore this ratio.However, this is merely a single case report and prospective double-blind, placebo-controlled studies are certainly needed.National Health Service, Dept. of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini,” ASL 4, Teramo, Italy (DdB, NS, FSM)Dept. of Neuroscience and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy (DdB, GM, MdG)Correspondence: Domenico De Berardis, M.D., Ph.D., National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, “G. Mazzini” Hospital; e-mail: [email protected]itThis case report was not funded by any research grants, and no pharmaceutical companies were informed of or involved in the case. The authors have no potential conflicts of interest that are directly relevant to the contents of the paper.References1 Kane JM, Barnes TR, Correll CU, et al.: Evaluation of akathisia in patients with schizophrenia, schizoaffective disorder, or bipolar I disorder: a post hoc analysis of pooled data from short- and long-term aripiprazole trials. J Psychopharmacol 2010; 24:1019–1029Crossref, Medline, Google Scholar2 Taylor CP, Angelotti T, Fauman E: Pharmacology and mechanism of action of pregabalin: the calcium channel alpha2-delta (alpha2-delta) subunit as a target for antiepileptic drug discovery. Epilepsy Res 2007; 73:137–150Crossref, Medline, Google Scholar3 Martinotti G, di Nicola M, Frustaci A, et al.: Pregabalin, tiapride, and lorazepam in alcohol withdrawal syndrome: a multi-centre, randomized, single-blind comparison trial. Addiction 2010; 105:288–299Crossref, Medline, Google Scholar4 Garcia-Borreguero D, Larrosa O, Williams AM, et al.: Treatment of restless legs syndrome with pregabalin: a double-blind, placebo-controlled study. Neurology 2010; 74:1897–1904Crossref, Medline, Google Scholar5 Poyurovsky M, Weizman R, Weizman A: Aripiprazole’s receptor pharmacology and extrapyramidal side effects. Am J Psychiatry 2008; 165:398, author reply 398–399Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByWhen and why aripiprazole causes extrapyramidal side effects: Three cases and mini reviewPsychiatry Research Case Reports, Vol. 1, No. 2Schizophrenia and Related Psychoses2 December 2021Case of aripiprazole long‐acting‐related akathisia successfully managed with carvedilol: A case report14 January 2021 | Psychiatry and Clinical Neurosciences, Vol. 75, No. 3The ‘collateral side’ of mood stabilizers: safety and evidence-based strategies for managing side effects21 September 2020 | Expert Opinion on Drug Safety, Vol. 19, No. 11Treating akathisia with pregabalin – A case report1 June 2019 | Archives of Clinical Psychiatry (São Paulo), Vol. 46, No. 3The Assessment and Treatment of Antipsychotic-Induced Akathisia23 April 2018 | The Canadian Journal of Psychiatry, Vol. 63, No. 11Movement Disorders Induced by the “Atypical” Antipsychotic AripiprazoleThe Neurologist, Vol. 22, No. 1Akathisia: Case Presentation and Review of Newer Treatment AgentsPsychiatric Annals, Vol. 44, No. 8Aripiprazole26 October 2013 | Reactions Weekly, Vol. 1475, No. 1 Volume 25Issue 2 Spring 2013Pages E09-E10 Metrics This case report was not funded by any research grants, and no pharmaceutical companies were informed of or involved in the case. The authors have no potential conflicts of interest that are directly relevant to the contents of the paper.PDF download History Published online 1 April 2013 Published in print 1 April 2013" @default.
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