Possible Aripiprazole-Induced Hypothermia: An "Icy" Side Effect?

Antipsychotics are a widely used class of drugs. They have been frequently associated with temperature dysregulation, especially hyperthermia. Hypothermia is also a rare but very serious side effect associated with these drugs. We present a case of possible aripiprazole-induced hypothermia with normothermia achieved after its discontinuation. An 81-year-old woman was brought into the emergency room with hypotension, hypothermia, and bradycardia. She was initially managed with intravenous fluids, external rewarming, and broad-spectrum antibiotics. Blood cultures and workup for infection returned negative with a low procalcitonin. Workup for endocrinopathy was also negative. She needed a Bair Hugger™ (3M, Maplewood, MN) to keep her temperature above 36 °C even after her other vital signs had normalized. Finally, her aripiprazole was held with the suspicion that it was causing hypothermia. Following this, her temperature improved and remained stable throughout even after discharge. Since hypothermia can be life-threatening, after ruling out common causes, clinicians should consider aripiprazole-induced hypothermia in these patients and the drug should be promptly discontinued.