Cariprazine and Lithium Overdose: A Case Report

Cariprazine is a third-generation antipsychotic used in the treatment of schizophrenia and bipolar affective disorder. This case describes a significant overdose of cariprazine and lithium, detailing the clinical features and management outcomes. A 24-year-old woman with a history of bipolar affective disorder and borderline personality disorder presented following an intentional overdose of approximately 60 mg of cariprazine and 3.75-5 g of lithium carbonate and ethanol. Her Glasgow Coma Scale score dropped from 15 to 3 briefly within three hours of ingestion, though she maintained airway patency and adequate oxygenation throughout. Serial electrocardiograms revealed no corrected QT prolongation. Serum lithium level peaked at 2.5 mmol/L six hours after ingestion. The patient was managed conservatively with intravenous fluids and close neurological monitoring and was fully alert and oriented within 12 hours. She was discharged without complications 48 hours after ingestion. This appears to be the largest reported cariprazine overdose in an adult to date, although confounded by coingestion of ethanol and lithium. The primary clinical effect observed was transient sedation without respiratory compromise or cardiac dysrhythmia. Further evidence is needed, but this case suggests that even large overdoses of cariprazine may be managed conservatively in the absence of other complications, supporting a cautious but noninvasive approach in similar presentations.