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Abstract
Study Objective. To characterize the clinical effects of acute isolated aripiprazole poisonings and to assess the toxic dose of this drug. Methods. All isolated acute aripiprazole exposures reported to a poison control system from January 2002 through September 2006 were retrospectively reviewed. Patients with incomplete information or those lost to follow-up were excluded. Results. A total of 286 cases were identified. Mean age was 18.9 years (SD 15.7), with a range of 6 months–70 years. Seventy-seven patients (27%) were ≤6 years, 80 patients (28%) were 7–17 years, and 129 patients (45%) were ≥18 years. Doses were known in 255 patients (89%). Symptoms occurred in 158 patients (55%): somnolence 89 (56%), tachycardia 32 (20%, heart rate 102–186), nausea/vomiting 29 (18%), dystonic reactions 21 (13%), tremor 9 (6%), agitation 3 (2%), dizziness 3 (2%), paresthesia 2 (1%), headache 2 (1%), dysphagia 1 (<1%), syncope 1 (<1%), minor facial swelling 1 (<1%), and hypotension 1 (<1%). None of the patients required intubation, and there were no deaths or EKG abnormalities. Median dose for symptomatic and asymptomatic groups were 25 and 15 mg, respectively, for ≤6 years (p = 0.02); 60 and 30 mg for 7–17 years (p = 0.01); and 100 and 75 mg for ≥18 (p = 0.25). In comparison of drug groups (Group 1, ≤20 mg; Group 2, 21–90 mg; Group 3, ≥91 mg), symptoms were more likely to occur in Group 2 versus Group 1 (OR 2.29, 95% CI 0.79–6.61) in patients ≤6 years; in Group 3 versus Group 1 (OR 3.39, 95% CI 1.07–10.73) followed by Group 2 versus Group 1 (OR 1.14, 95% CI 0.36–3.56) in patients 7–17 years; and in Group 3 versus Group 1 (OR 1.36, 95% CI 0.54–3.42) but not any more likely in Group 2 versus Group 1 (OR 0.92, 95% CI 0.33–2.52) in patients ≥18 years. Conclusions. Acute aripiprazole poisonings most commonly result in sedation, sinus tachycardia, nausea/vomiting, or dystonic reactions. Symptoms are more likely with doses above 90 mg, although pediatric patients can be affected at a lower dose.