Aripiprazole (Abilify) is an atypical antipsychotic medication prescribed to manage conditions such as schizophrenia, bipolar I disorder, and major depressive disorder. It functions as a partial agonist at dopamine D2 receptors and an antagonist at serotonin 5-HT2A receptors. Due to its effectiveness, an overdose presents a serious medical emergency requiring immediate, professional medical intervention. Understanding the signs of toxic ingestion is the first step in responding effectively. This information is for educational purposes only and is not a replacement for guidance from a healthcare provider.
Identifying Symptoms of an Overdose
The most common initial sign of Aripiprazole toxicity is significant central nervous system (CNS) depression, manifesting as profound lethargy or drowsiness that can progress to a coma. Sedation can be prolonged, sometimes lasting for days, due to the drug’s long half-life. Cardiovascular changes, such as an abnormally fast heart rate (tachycardia) and low blood pressure (hypotension), can also occur.
Involuntary movement disorders, known as Extrapyramidal symptoms (EPS), may appear, including tremors, muscle rigidity, and sustained muscle contractions (dystonia). In rare but severe cases, patients may develop Neuroleptic Malignant Syndrome (NMS), a life-threatening condition characterized by muscle rigidity, high fever, and changes in mental status. Seizures or shallow breathing further indicate a severe toxic reaction.
Critical Steps for Immediate Response
If an Aripiprazole overdose is suspected, immediately call local emergency services (such as 911 or 112). Simultaneously, contact the regional Poison Control Center, as they provide specific treatment recommendations to hospital staff. If known, provide the amount of medication ingested, the time of ingestion, and any other substances taken.
While waiting for medical assistance, maintain basic life support by ensuring the person’s airway remains open and they are breathing adequately. If the individual is unconscious or seizing, move them to a safe position, such as lying on their side, to prevent injury. Never attempt to induce vomiting, as this increases the risk of aspiration, especially if consciousness is impaired.
Advanced Medical Management in the Hospital
Treatment for an Aripiprazole overdose is primarily supportive, as there is no specific antidote to reverse the drug’s effects. For a recent, large ingestion, gastric decontamination may involve administering activated charcoal. Charcoal works by binding to the drug in the gastrointestinal tract, preventing its absorption into the bloodstream. However, charcoal is often avoided if the patient is too drowsy, due to the risk of aspiration.
Supportive care focuses on maintaining stable bodily functions, starting with continuous cardiac monitoring to detect abnormal heart rhythms. If the patient develops low blood pressure (hypotension), intravenous fluids are administered first to restore blood pressure. If fluids are insufficient, vasopressors may be used to constrict blood vessels and raise blood pressure. Respiratory depression or failure requires immediate intervention, potentially including intubation and mechanical ventilation.
Seizures are typically managed with intravenous benzodiazepines, a class of medication that calms excessive electrical activity in the brain. Severe Extrapyramidal symptoms (EPS), such as acute dystonia, are commonly treated with anticholinergic agents like diphenhydramine or benztropine. If Neuroleptic Malignant Syndrome (NMS) is diagnosed, management includes aggressive cooling measures and the use of muscle relaxants to control severe muscle rigidity.
Post-Acute Care and Follow-Up
Because the half-life of oral Aripiprazole is approximately 75 hours, a prolonged period of observation is necessary, often lasting several days. This extended monitoring ensures the medication is fully eliminated from the body and prevents delayed or recurrent toxicity. Continuous cardiac monitoring is maintained during this time to watch for any delayed conduction abnormalities.
Laboratory assessments are conducted to check for potential secondary complications, including monitoring renal and hepatic function for signs of organ strain. Once medically stable, follow-up care requires an immediate psychiatric consultation and a comprehensive risk assessment. Addressing the underlying crisis that led to the overdose is fundamental to preventing future episodes and establishing a long-term safety plan.