Question about Abilify and Akathisia (Topamax conerned as well)

[Pamster]

My son is ten and takes abilify, he was getting 10 mgs a day, for a month and a half before he began getting aggressive and pacing a lot and iritiable and his p-doc immediately called it Akathisia and wants us to wean him down, which prompts us to talk about weaning him off the medicine altogether, but I am not so sure we're going to get there right away. We decreased his dose to 7.5 mgs. and I am also worried about the topamax he takes and has been taking for about two years.

I want him off that more then the abilify because I have read some horrific stories about what it did to some people. I want to get him down to 5 mgs of Abilify and hope and pray he's stable enough to go down on the topamax 25 mgs. at a time, I have talked to the pharmacist and the drs about weaning him so my real questions are do you think that it's really possible to develop akathisia after taking abilify for over a year and show it like a month and a half after a small 2.5 mg increase? I really don't think it's akathisia, and his peditrician didn't either and the p-doc only heard what I told her from school and from what I am seeing at home.

He is autistic and has seizure disorder and had been stable for quite some time. The 2.5 mg increase we did initially seemed to help with his aggression big time, and I am at a loss as to how much aggressive behavior he's actually got now that he's been taking the smaller dose of the medication, I mean he's throwing shoes at me and hitting me, not constantly, but an awful lot. I knew it was going to be hard to manage his aggression, but this is just terrible. We go to the p-neuro on monday and I feel like cancelling and rescheduling because he's so darn aggressive I am scared to take him with me alone to the dr's.

We take the medical transportation so it's not like I would be driving with him, that's not going to happen any time soon. But I know we need to go see her so I am going to tough it out and just hope for the best. Isn't akathisia more common as a side effect when you're just starting a new medication and not something you see when you're taking a drug for over a year and been fine with it up until another small increase?

Thanks for any advice on this, I think that his lamictal and clonidine will help get us through this, and he needs those two drugs, or he'd have seizures and he wouldn't be calm enough to sleep at night or to go to school. But we're anxious to see what he's like just on those two things alone since not too long ago that was all he took and he seemed to be pretty good. I really don't think he had akathisia, and I think we should have gone up on the abilify not down. But we're committed to this course of action, it's just that the aggression is just so hard to handle at his size, it's really horrible.

[Midge]

I did a lot of research about Topomax and the only site that has come across as completely honest is from a user of the med called 'Crazymeds.org' click here (http://www.crazymeds.org/topamax.html) They give the good the bad and the odd side of the medication they have tried and taken. As I mentioned at the beginning I did a lot of research about Topomax and it is very hard to get an honest opinion about the side effects. I have taken it for around 3 years now starting with 25mg now at 400mg per day. I take it for nerve pain not epilepsy so cannot help with any info there. The side effects I have suffered have been weight loss (I later regained) constant dehydration that is a never-ending battle I now have to use fake tears, saliva and a vaginal lubricant. Dry skin which makes my eczema flare up. And memory loss. I would change medication but the side effects of the other type available to me are far worse. I have not known any other side effect with these meds.

[Pamster]

Thanks you for your reply Midge, I think weaning him will go ok, and I think it's better today then it was the other day when I posted, it's been a crazy day, but nothing like last week. I really appreciate you looking into topamax for me, I think I came across the crazymeds site last week when I was searching out info and you're right it has the good and the bad listed which is great. :)

Best wishes with the continued use of topamax, I hope it continues to get the relief you need. Nerve pain is no picnic. :(

[Lara]

Hi Pamster,
just saw your thread title in the list. There's an article in PubMed that is about Abilify/Aripiprazole and Tardive Dyskinesia but in that article it does mention akathisia.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16816781&query_hl=2&itool=pubmed_docsum
CNS Spectr. 2006 Jun;11(6):435-9. Links
Aripiprazole-related tardive dyskinesia.
Maytal G, Ostacher M, Stern TA.

Psychiatric Consultation Service, Massachusetts General Hospital, Boston, MA 02114, USA.

The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade. Aripiprazole, the newest medication in this class, has been associated with extrapyramidal symptoms (eg, akathisia) and with improvement of tardive dyskinesia (TD), but to date it has not been associated with the development of TD. We report a case of TD associated with the use of aripiprazole 15 mg/day for 18 months for refractory depression. Symptoms of TD resolved within several weeks of discontinuation of aripiprazole.

PMID: 16816781 [PubMed - indexed for MEDLINE]

Abilify has some drug/drug interactions. I've run out of time to look at that right now. Will try to get back later.

Also, Abilify is one of the meds. some people use to calm their tics, so if I see anything important in my travels I'll post it for you.

p.s. just posting Abilify info. from prescriber. http://www.fda.gov/MEDWATCH/safety/2006/Oct_PIs/AbilifyTabs_PI.pdf
did a quick check but run out of time here.

[Pamster]

Thanks Lara, I appreciate the time you put into researching it for me. :) I know we're aiming to get him off of it soon, but I am more worried about the topamax at the moment, because he has been taking it for almost two years and I think it's time it's stopped since I can't see where it's helping him anymore. The abilify seems to be leveled out and he's not pacing like he was or being as terribly hard to handle as he was last week, it's still hard, but not impossible. :)

[Lara]

Something else I was thinking about was what Midge said about the dehydration with the Topamax. My son experienced dehydration with Clonidine and your son is taking both.

That happened with my son when he was taking Clonidine, pamster, and it was only a small dose. He became very dehydrated very easily. He also became very agitated and aggressive when coming off Risperdal and it was a very low dose. We shaved it and extended the discontinuation period by a couple of months or so, but he still appeared to be experiencing difficulty when coming off it. I don't know what dose of clonidine your son is on, but I imagine it's very small, but we noticed side effects that were not supposed to exist on such small doses.

Another thing to remember is that our children on autism spectrum tend to sometimes have very strange reactions to medications. They're very sensitive to them. Another thing I was thinking was that as the Abilify dose is going down, that'd be affecting how your son is feeling as well... even if it's in minute doses.

I'm really sorry that your son is having such a difficult time right now. I'm hoping that when things are stabilized more with the medications that he'll settle down a lot better. (((Pamster))) I understand your worry.


If you run a search in a drug drug interactions site, it comes up with interactions for

topiramate and aripiprazole = should be monitored closely for evidence of decreased sweating and increased body temperature

clonidine and aripiprazole = Close clinical monitoring for development of hypotension is recommended

clonidine and lamotrigine = Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

clonidine and topiramate = Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

lamotrigine and aripiprazole = Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

aripiprazole (moderate Drug-Food) = Grapefruit juice

http://drugs.com/xq/cfm/pageID_1150/int_1/list_1/values_drugid%3Dd00044%26drugid%3Dd04115%26drugid% 3Dd03809%26drugid%3Dd04825%26/OpText_Abilify/dr_%2Cclonidine%2CTopamax%2CLamictal%2CAbilify/qx/index.htm#

[Pamster]

Boy it sounds like we're skirting disater on what he takes all around. Thank you for posting this I will definitely be on the alert to his reactions to the decreasing doses as we wean him off this drug. Thank you so much for all you did Lara, I had no idea it was such a delicate balance as it is. We do get regular blood tests and he has his blood pressure checked monthly. So we are doing the right things but it's still scary. :(

[Lara]

Well, The information that I posted was fairly vague even though it did mention interactions. I would certainly talk to the doctor about all this.

And it is sometimes a delicate balance ... esp. with our children who are so sensitive, plus you've got weight changes, growth spurts, interacting medications, autism etc.

Pamster, the best thing is to talk to your son's prescribing doctor or doctors. If more than one doctor is prescribing the meds. for different conditions, just make sure that they're aware. At once stage I got one doctor involved who acted as an overseer. All reports would go to him after we visited the other ones, that way one doctor was in control of all the information. Hopefully he'll settle down a lot once he's off the Abilify. Decreasing meds. like that can be very difficult for an adult, let alone a child. It might take some time to balance out once he's totally off it, but just hang on there, it's sure to happen.

[Pamster]

Thank you Lara, that is just what I am planning on doing. I have called twice but she's not yet returned my call, so hopefully tomorrow we'll hear something from her because I am calling his regular peditrician tomorrow to talk to her about it. Thanks again for all you posted. I was afraid no one would see my post here. I am glad I was wrong. :)

[Mayzoo]

Don't know if anyone already linked this here:

http://www.topamax.com/html/ptop/topamax-pi.jsp;jsessionid=JUIVURWZRAZP0CQPCCGTC0YKB2IIQNSC ?

It is a PDF link for the package insert (full prescribing) info for Topamax. For almost any brand name drug just type in www.name of drug.com--then look for the link to prescribing info.

[Pamster]

Thank you for that link Mayzoo. I hadn't seen it before and I appreciate it a lot. :D