What to do if Abilify (aripiprazole) was given accidentally?

Management of Accidental Abilify (Aripiprazole) Administration

If aripiprazole was given accidentally, immediately assess the dose ingested, patient age, symptoms, and time since ingestion—then contact poison control (1-800-222-1222) or seek emergency care if the patient shows anything beyond mild drowsiness or has ingested threshold-exceeding doses. 1, 2

Immediate Assessment Steps

Determine if emergency department referral is needed based on these criteria:

• Any patient with self-harm intent or malicious administration should go to the emergency department immediately, regardless of dose 2
• Any symptoms beyond mild drowsiness (moderate sedation, inability to arouse with voice/light touch, confusion, tremor, tachycardia, vomiting) warrant emergency department evaluation 2, 3
• Time-sensitive evaluation: If the patient is asymptomatic and more than 6 hours have passed since ingestion, they are unlikely to develop symptoms and can be observed at home with follow-up 2

Dose-Based Thresholds for Home Observation

For children under 12 years old (medication-naïve):

• Can observe at home if dose is less than 15 mg aripiprazole AND experiencing no more than mild drowsiness 2
• Emergency department referral required if dose equals or exceeds 15 mg 2

For patients 12 years and older (medication-naïve):

• Can observe at home if dose is less than 50 mg aripiprazole AND experiencing no more than mild drowsiness 2
• Emergency department referral required if dose equals or exceeds 50 mg 2

For patients on chronic aripiprazole therapy:

• Can observe at home unless they ingested more than 5 times their current single dose 2

Clinical Toxicity Profile

Young children are at highest risk for significant toxicity:

• A 2-year-old who ingested just 10 mg (two 5-mg tablets) developed marked lethargy, tremor, and tachycardia persisting over 72 hours with a drug level of 160 ng/mL at 34 hours post-ingestion 3
• Another 2-year-old ingesting 40 mg experienced vomiting and significant lethargy lasting approximately 30 hours 4
• Adolescents generally tolerate larger doses better, with cases of 120-300 mg producing minimal or transient symptoms 5, 4

Expected symptoms include:

• Lethargy and sedation (most common) 1, 3, 4
• Gastrointestinal upset (vomiting, nausea) 1, 4
• Tremor and extrapyramidal symptoms 3
• Tachycardia 3
• Orthostatic hypotension and dizziness 1
• Confusion 1

Home Observation Protocol

If home observation is appropriate:

• Instruct caregivers to call poison control if symptoms develop or worsen 2
• Poison center should make follow-up calls until at least 6 hours after ingestion if mild drowsiness is present 2
• Do not observe during normal sleep hours—consider emergency department referral if observation would occur when patient or caregiver would normally be sleeping 2
• Monitor for at least 72 hours in young children given prolonged toxicity potential 3

What NOT to Do

• Do not induce emesis 2
• Do not delay transportation to administer activated charcoal if emergency department evaluation is warranted 2
• There is no specific evidence supporting out-of-hospital activated charcoal administration for aripiprazole exposures 2

Emergency Department Transport Considerations

If emergency department evaluation is needed:

• Consider ambulance transport based on patient condition and distance to hospital 2
• Implement continuous cardiac monitoring during transport (conduction disturbances have been reported with atypical antipsychotics) 2
• Provide supportive care including airway management and IV fluids for hypotension 2

Special Warnings from FDA Labeling

Contact healthcare provider immediately if overdose occurs 1:

• Call poison control at 1-800-222-1222 1
• Go to nearest emergency room 1
• Serious risks include neuroleptic malignant syndrome (high fever, stiff muscles, confusion, sweating, pulse/blood pressure changes), uncontrolled body movements, metabolic problems, seizures, and temperature regulation problems 1

Key Clinical Pitfall

The most critical error is underestimating toxicity risk in young children—even small doses (10 mg) can produce prolonged, significant symptoms in toddlers due to aripiprazole's long half-life and higher drug levels achieved in smaller patients 3, 4. When in doubt with pediatric exposures, err on the side of emergency department evaluation.