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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Adrienne Hughes
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
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Janson JA, Wasylewicz ATM, Eijkemans M, Kerskes M. Citalopram intoxication in four week old infant. BMC Pediatr 2020; 20:552. [PMID: 33287753 PMCID: PMC7722423 DOI: 10.1186/s12887-020-02439-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background In contrast to intoxications in toddlers which can be due to accidental ingestions, many intoxications in infants are due to medication errors. To our knowledge, this is the first case report of a citalopram intoxication in an infant, and may offer new insight on possible screening methods for intoxication as well as pharmacokinetics of citalopram in small infants. Case presentation This case report describes an unintentional citalopram intoxication in a 4 week old infant due to a vitamin D drops ‘look alike’ error. The infant showed extreme jitteriness and opisthotonus at presentation, as well as prolonged signs of gastro-oesophageal reflux. No cardiac rhythm disturbances or convulsions were seen. The clinical course combined with Finnegan scores was correlated to and supported by pharmacokinetic and pharmacokinetic data of citalopram in the patient. Conclusions Using Finnegan scores in general pediatric practice could help objectify follow-up of acute intoxications in young infants with neurological symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-020-02439-5.
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Affiliation(s)
- Jo-Anne Janson
- Pediatrics, Maastricht UMC+, Maastricht, The Netherlands
| | | | - Marianne Eijkemans
- Pediatrics, Catharina Hospital, Michelangelolaan 2, 5623, EJ Eindhoven, The Netherlands.
| | - Marieke Kerskes
- Pharmacology, Catharina Hospital, Eindhoven, The Netherlands
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Czaja AS, Anderson HD, Ghosh D, Davidson J, Campbell JD, Valuck RJ. Increased Odds of Ventricular Arrhythmias Associated with Selective Serotonin Reuptake Inhibitor Use among the Pediatric and Young Adult Population: A Case-Control Study. J Pediatr 2020; 226:173-178.e8. [PMID: 32645405 DOI: 10.1016/j.jpeds.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/31/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To measure the association between selective serotonin reuptake inhibitor (SSRI) use and out-of-hospital ventricular arrhythmia among the pediatric and young adult population. STUDY DESIGN Case-control study using US claims data from 2007 to 2018. Cases were subjects with at least 1 event between ages 2 and 24 years. Controls (matched 10:1 on index date, age, sex, and continuous enrollment) had no events during study period. Independent association between current SSRI use (prescription fill with continuous exposure ending on, or after, the index date) and incident out-of-hospital ventricular arrhythmia (hospitalization or emergency room encounter with primary diagnostic code for ventricular arrhythmia) was estimated using multivariable conditional logistic regression. Separate analyses were performed for pediatric (2-17 years of age) vs young adult (18-24 years of age) subjects and between citalopram/escitalopram vs other SSRIs. RESULTS During the study period, 237 eligible cases were identified with 2370 matched controls. Cases were more likely to have government insurance and have a mental health, cardiac, or other complex chronic condition. Thirteen cases (5%) and 15 controls (<1%) had current SSRI exposure. After adjustment for mental health and chronic conditions, there was an increased odds of current SSRI use among cases compared with controls (OR 5.11, 95% CI 1.22-21.37). No difference was observed between pediatric and young adult ages, nor between citalopram/escitalopram and other SSRIs. CONCLUSIONS These findings demonstrate increased odds of out-of-hospital ventricular arrhythmia associated with SSRI use in the pediatric and young adult population, suggesting a need for heightened awareness and ongoing monitoring of this potential adverse effect.
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Affiliation(s)
- Angela S Czaja
- Department of Pediatrics, Critical Care Section, School of Medicine, University of Colorado, Aurora, CO.
| | - Heather D Anderson
- Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes (CePOR), Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | - Debashis Ghosh
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Jesse Davidson
- Department of Pediatrics, Cardiology Section, School of Medicine, University of Colorado, Aurora, CO
| | - Jonathan D Campbell
- Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes (CePOR), Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | - Robert J Valuck
- Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes (CePOR), Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
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5
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Abstract
Serotonin syndrome (SS) is a serious toxicity that manifests with symptoms such as tremor, hyperthermia, agitation, and altered mental status that may lead to seizures, coma, or death. Selective serotonin reuptake inhibitors may precipitate SS, particularly in combination with other drugs that possess serotonergic activity. We present a case of SS in a 14-month-old after an ingestion of the selective serotonin reuptake inhibitor vilazodone.
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Abstract
Vilazodone hydrochloride is the first member in a new class of antidepressants called indolealkylamines and was approved for use in the United States in 2011 for major depressive disorder. It has a combined mechanism of action of a selective serotonin reuptake inhibitor and a partial agonist of serotonin 5-HT1A receptors. It has not been approved for use in the pediatric population, and toxicity from exploratory vilazodone ingestion has been rarely described to date. We describe 2 children with laboratory-confirmed vilazodone ingestions that led to significant toxicity including refractory status epilepticus in 1 patient and likely transient seizure activity in the other. Both patients required multiple doses of benzodiazepines; in the more severe case, barbiturates were added to control seizure activity. These children returned to baseline and had no prolonged neurologic complications. Pediatric experience with vilazodone is limited; however, the literature demonstrates 3 additional case reports of children experiencing seizure after vilazodone ingestion. With the 2 new cases presented here, it seems prudent to educate prescribers and families of the potential dangers of ingestion of vilazodone tablets by young children.
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Greene S, AufderHeide E, French-Rosas L. Toxicologic Emergencies in Patients with Mental Illness: When Medications Are No Longer Your Friends. Psychiatr Clin North Am 2017; 40:519-532. [PMID: 28800806 DOI: 10.1016/j.psc.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with psychiatric disorders are at risk for toxicologic emergencies. Psychotropic medications have numerous effects on the neurologic, cardiac, and other organ systems and interact with other medications, potentially leading to further side effects. It is important to become familiar with accepted psychiatric practice guidelines, common toxidromes, medical sequelae associated with prescribed medications, and the specific workup and treatment of overdoses of frequently prescribed psychotropics.
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Gaw CE, Spiller HA, Russell JL, Chounthirath T, Smith GA. Evaluation of dose and outcomes for pediatric vilazodone ingestions. Clin Toxicol (Phila) 2017; 56:113-119. [DOI: 10.1080/15563650.2017.1347263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Christopher E. Gaw
- Center for Injury Research and Policy, Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Division of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Henry A. Spiller
- Central Ohio Poison Center, Columbus, OH, USA
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jason L. Russell
- Central Ohio Poison Center, Columbus, OH, USA
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Thiphalak Chounthirath
- Center for Injury Research and Policy, Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gary A. Smith
- Center for Injury Research and Policy, Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
- Child Injury Prevention Alliance, Columbus, OH, USA
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Russell JL, Spiller HA, Chounthirath T, Casavant MJ. Pediatric ingestion of vilazodone compared to other selective serotonin reuptake inhibitor medications. Clin Toxicol (Phila) 2017; 55:352-356. [DOI: 10.1080/15563650.2017.1287375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jason L. Russell
- Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Central Ohio Poison Center, Columbus, OH, USA
| | - Henry A. Spiller
- Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Central Ohio Poison Center, Columbus, OH, USA
| | - Thiphalak Chounthirath
- Nationwide Children’s Hospital, Columbus, OH, USA
- Center for Injury Research and Policy, Columbus, OH, USA
| | - Marcel J. Casavant
- Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Central Ohio Poison Center, Columbus, OH, USA
- Center for Injury Research and Policy, Columbus, OH, USA
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Degiacomo J, Luedtke S. Neonatal Toxicity From Escitalopram Use In Utero: A Case Report. J Pediatr Pharmacol Ther 2016; 21:522-526. [PMID: 28018155 DOI: 10.5863/1551-6776-21.6.522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Selective serotonin reuptake inhibitor (SSRI) exposure during pregnancy can result in symptoms of serotonin syndrome or serotonin withdrawal. In contrast to other SSRIs, reports of serotonin behavioral syndrome following in utero exposure to escitalopram and citalopram are limited. We describe a case of suspected toxicity following in utero exposure to 20 mg escitalopram throughout pregnancy. The infant was transferred to our neonatal intensive unit at 9 hours of life for further evaluation of lethargy, weak cry, bradycardia, and non-reactive pupils. Hypoxic ischemic encephalopathy was suspected upon presentation, despite APGAR scores of 8 and 9. Upon admission, symptoms progressed to signs of hypertonia, irritability, high-pitched cry, and posturing. The patient was loaded with phenobarbital for empiric management of suspected seizures versus drug withdrawal. Both electroencephalogram and computed tomography scan results were normal; however, an electrocardiogram revealed a prolonged QTc interval of 531 milliseconds. Signs of irritability and QTc prolongation continued through day of life (DOL) 5. The infant was discharged on DOL 10 with no further symptoms. We hypothesize that this represented a case of serotonin toxicity due to in utero exposure to escitalopram and recommend close monitoring for neonatal behavioral syndrome symptoms and QTc prolongation in infants exposed to escitalopram during pregnancy.
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Affiliation(s)
- Jessica Degiacomo
- University of Virginia Health System Children's Hospital, Charlottesville, Virginia
| | - Sherry Luedtke
- Texas Tech University Health Sciences Center School of Pharmacy, Amarillo, Texas
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Acute Vilazodone Toxicity in a Pediatric Patient. J Emerg Med 2015; 49:284-6. [DOI: 10.1016/j.jemermed.2015.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
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Uchida M, Spencer AE, Biederman J, Castro VM, Kenworthy T, Chan J, Rosales AM, Newton-Cheh C, Perlis RH. A Systematic Evaluation of the QTc Interval and Antidepressants in Youth: An Electronic Health Record Study. J Dev Behav Pediatr 2015; 36:434-9. [PMID: 26154713 DOI: 10.1097/dbp.0000000000000188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The US Food and Drug Administration announced that citalopram was associated with dose-related prolongation of the QTc interval in adults. This study aimed to assess how antidepressants affect QTc intervals in children. The authors hypothesized that some antidepressants would show an association with QTc prolongation. METHODS An electronic medical record review was conducted of children aged 5 to 18 years in the Partners Healthcare system with at least 1 prescription of an antidepressant or methadone between February 1990 and August 2011. The authors extracted lifetime diagnoses and QTc interval of patients who had received an electrocardiogram 14 to 90 days after antidepressant or methadone prescription (N = 297). The mean QTc per medication was calculated as compared with the mean of all QTc measurements across medications. The number of patients taking medications who had QTc values in normal, borderline, abnormal, or high were also calculated. RESULTS Mean QTc values for all medications were in the normal range. The highest mean QTc was in patients on escitalopram (436 milliseconds). The mean QTc for sertraline (416 milliseconds) was significantly lower than all other drugs measured (t(331) = -2.21, p < .05). After controlling for confounding effects, none of the differences in mean QTc compared with other study drugs reached statistical significance. The greatest percentages of abnormal and high QTc values were found among patients taking paroxetine (18.8%), followed by escitalopram (15.4%). None of the children had documented ventricular arrhythmia. CONCLUSION The results suggest that most antidepressants are not associated with prolonged QTc at doses typically prescribed for children.
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Affiliation(s)
- Mai Uchida
- *Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA; †Partners Research Computing, Partners HealthCare System, Boston, MA; ‡Department of Pediatrics, Massachusetts General Hospital, Boston, MA; §Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA; ‖Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston, MA
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Czaja AS, Valuck RJ, Anderson HD. Comparative safety of selective serotonin reuptake inhibitors among pediatric users with respect to adverse cardiac events. Pharmacoepidemiol Drug Saf 2013; 22:607-14. [DOI: 10.1002/pds.3420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/15/2013] [Accepted: 01/20/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Angela S. Czaja
- Department of Pediatrics, School of Medicine; University of Colorado; Aurora CO USA
- Children's Hospital Colorado; Aurora CO USA
| | - Robert J. Valuck
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado; Aurora CO USA
- Department of Epidemiology, Colorado School of Public Health; University of Colorado; Aurora CO USA
- Department of Family Medicine, School of Medicine; University of Colorado; Aurora CO USA
| | - Heather D. Anderson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado; Aurora CO USA
- Department of Epidemiology, Colorado School of Public Health; University of Colorado; Aurora CO USA
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Beaune S, Callebert J, Baud FJ, Risède P, Juvin P, Mégarbane B. Mechanisms of high-dose citalopram-induced death in a rat model. Toxicology 2012; 302:248-54. [DOI: 10.1016/j.tox.2012.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 12/25/2022]
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Carstairs SD, Griffith EA, Alayin T, Ejike JC, Cantrell FL. Recurrent Seizure Activity in a Child After Acute Vilazodone Ingestion. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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