Acute Vilazodone Toxicity in a Pediatric Patient

Acker, Emily; Sinclair, Elizabeth A.; Beardsley, Andrew L.; Ahmed, Sheikh Sohail; Froberg, Blake

doi:10.1016/j.jemermed.2015.04.032

Cited by 15 publications

(5 citation statements)

References 7 publications

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“…There have been case reports/series and analyses of poison center reports on the signs and symptoms of vilazodone overdose in young children [5–12]. Tachycardia, agitation, tremor, and seizures were more common in poison center data with pediatric vilazodone ingestions as compared to other SSRIs [8, 12].…”

Section: Discussionmentioning

confidence: 99%

“…The medication reaches peak serum concentration 4 to 5 h after ingestion [4]. The most commonly reported effects in overdose are drowsiness, vomiting, tachycardia, and agitation [5–12]. Seizures and serotonin syndrome have been reported in accidental pediatric ingestions [5, 6, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…The most commonly reported effects in overdose are drowsiness, vomiting, tachycardia, and agitation [5–12]. Seizures and serotonin syndrome have been reported in accidental pediatric ingestions [5, 6, 9, 10]. The United States National Poison Data System contained 753 reports of vilazodone ingestions in children younger than 6 years of age from 2011 through 2016 [8].…”

Section: Introductionmentioning

confidence: 99%

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Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

et al. 2019

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Background Vilazodone is an FDA approved medication used to treat major depressive disorder. The authors describe two cases of accidental vilazodone exposure in toddlers who presented with symptoms similar to amphetamine exposure and also with unexplained positive amphetamine urine immunoassay drug screens. Given a lack of published data on cross-reactivity of vilazodone and its metabolites with drug of abuse screening tests, the authors investigated drug of abuse immunoassay cross-reactivity of vilazodone and metabolites using computational and empirical approaches. Methods To ascertain the likelihood that vilazodone would cross-react with drug of abuse screening immunoassays, the authors assessed the two-dimensional (2D) similarity of the vilazodone parent molecule and known metabolites to an array of antigenic targets for urine immunoassay drug screens. To facilitate studies of the commercially unavailable M17 metabolite, it was prepared synthetically through a novel scheme. Urine and serum were spiked with vilazodone and M17 into urine (200–100,000 ng/mL) and serum (20–2000 ng/mL) samples and tested for cross-reactivity. Results Computational analysis using 2D similarity showed that vilazodone and metabolites have generally low similarity to antigenic targets of common drug of abuse screening immunoassays, predicting weak or no cross-reactivity. The M17 metabolite had 2D similarity to amphetamines and tricyclic antidepressants in a range similar to some other compounds exhibiting weak cross-reactivity on these immunoassays. Cross-reactivity testing was therefore performed on two different urine amphetamines immunoassays and a serum tricyclic antidepressant immunoassay. However, actual testing of cross reactivity for vilazodone and the M17 metabolite did not detect cross-reactivity for any urine amphetamines screen at concentrations up to 100,000 ng/mL and for a serum tricyclic antidepressants assays at concentrations up to 2000 ng/mL. Conclusion While the vilazodone metabolite M17 has weak 2D structural similarity to amphetamines and tricyclic antidepressants, the current study did not demonstrate any experimental cross-reactivity with two different urine amphetamines immunoassays and a serum tricyclic antidepressant immunoassay. Vilazodone ingestions in young children present a diagnostic challenge in their similarity to amphetamine ingestions and the lack of routine laboratory tests for vilazodone. Further work is needed to understand the metabolic profile for vilazodone in children versus adults. Electronic supplementary material The online version of this article (10.1186/s12907-019-0084-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

et al. 2019

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“…However, other available and better reported data as listed in (n = approx. 85,000) * [27] FDA data: 0.1 % (3/2181) [47] Vilazodone (3) SRI, 5-HT1A receptor partial agonist 2 CR [174][175] 1 CR exacerbation [176] Vortioxetine (0) SRI, 5-HT1A and 5-HT1B receptor partial agonist ADR: adverse drug reaction; CR: case report; FDA: Food and Drug Administration; GM: Grand Mal Seizure; NRI: norepinephrine reuptake; inhibitor; RCT: randomized controlled trial; SE: status epilepticus; SIR: standardized incidence ratio; SZ: seizure; SNRI: serotonin and norepinephrine reuptake inhibitor; SRI: serotonin reuptake inhibitor * n can only approximately be determined from a graph in this publication…”

Section: Discussionmentioning

confidence: 99%

Epileptic Seizures Under Antidepressive Drug Treatment: Systematic Review

Steinert

Fröscher²

2017

Pharmacopsychiatry

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“…16 Many drugs that do not trigger seizures at therapeutic doses may do so in overdose; examples are citalopram, 17 escitalopram, 17 and vilazodone. 18 If modafinil carries a seizure risk, the overdose data could unmask the risk. So, what do the data show?…”

Section: Overdosementioning

confidence: 99%

A Method for Deciding About the Possible Safety of Modafinil and Armodafinil in Patients With Seizure Disorder

Andrade

2016

J. Clin. Psychiatry

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Acute Vilazodone Toxicity in a Pediatric Patient

Cited by 15 publications

References 7 publications

Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

Epileptic Seizures Under Antidepressive Drug Treatment: Systematic Review

A Method for Deciding About the Possible Safety of Modafinil and Armodafinil in Patients With Seizure Disorder

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