Cetirizine overdose in a young child

Ridout, S.; Tariq, Syed Maaz

doi:10.1016/s0091-6749(97)80028-0

Cited by 38 publications

(19 citation statements)

References 1 publication

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“…The boy survived the episode. 12 When we supplemented aliquots of carbamazepine pool with up to 0.50 mg/mL hydroxyzine or cetirizine, we observed no statistically significant increases in carbamazepine values measured by the PENTINA assay indicating that after therapeutic use of hydroxyzine or cetirizine as well as after modest overdose with these drugs, the PENTINA carbamazepine assay should not be affected by this interference. However, with higher hydroxyzine as well as cetirizine concentrations, both statistically significant and clinically significant increases in carbamazepine values were observed using the PENTINA assay indicating that this assay is unsuitable to determine carbamazepine concentration in a patient overdose with either hydroxyzine or cetirizine (Table 2).…”

Section: Discussionmentioning

confidence: 75%

“…In contrast, no apparent carbamazepine concentration was observed using the ADVIA Centaur assay even at a hydroxyzine level of 102.7 mg/mL, the highest hydroxyzine level reported in a patient. 12 These results indicate the ADVIA Centaur assay is completely free from hydroxyzine and cetirizine interference (Table 1). However, the expected in vivo hydroxyzine concentrations after therapeutic use are roughly 0.10 mg/mL and the usual peak cetirizine level after therapeutic use is 0.30 mg/mL.…”

Section: Resultsmentioning

confidence: 87%

“…An additional five aliquots were prepared to mimic concentration of these drugs reported in cases of toxicity or overdose involving both adult and pediatric patients. [8][9][10][11][12] To ensure that a small amount of ethanol does not interfere with the carbamazepine immunoassay, we added a microliter amount of ethanol working or standard solution to a test tube first and then evaporated ethanol under a stream of nitrogen followed by reconstituting the dry residue with an appropriate amount of drug-free serum. To ensure dry residue was completely dissolved in serum, we performed visual inspection of each specimen after reconstitution to ensure that that there was no floating particle in each specimen.…”

Section: Methodsmentioning

confidence: 99%

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Hydroxyzine and Cetirizine Interfere With the PENTINA Carbamazepine Assay but Not With the ADVIA CENTEUR Carbamazepine Assay

Dasgupta¹,

Tso²,

Johnson³

et al. 2010

Therapeutic Drug Monitoring

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Because of a published report indicating significant interference of hydroxyzine with the particle-enhanced turbidimetric inhibition immunoassay (PENTINA) carbamazepine assay, we investigated whether such interference can be avoided by using the ADVIA Centaur carbamazepine assay. Both the Dimension Vista analyzer and ADVIA Centaur analyzer are available from Siemens Diagnostics. Aliquots of a drug-free serum pool were supplemented with various concentrations of hydroxyzine or cetirizine (0.05 microg/mL to 20 microg/mL covering therapeutic and toxic levels in serum) followed by analysis using both assays. We observed significant apparent carbamazepine concentrations using the PENTINA assay but no apparent carbamazepine level using the ADVIA Centaur assay. Because crossreactivity should be studied in the presence of the primary analyte, we also prepared a serum carbamazepine pool from patients receiving carbamazepine and then supplemented aliquots of this pool with various amounts of hydroxyzine or cetirizine followed by reanalyzing carbamazepine concentration using both assays. We observed falsely elevated carbamazepine values using the PENTINA assay but no interference was observed using the ADVIA Centaur assay. However, the falsely elevated carbamazepine values using the PENTINA assay were clinically significant at hydroxyzine or cetirizine concentrations expected in patients with severe overdoses with these drugs. We conclude that the ADVIA Centaur carbamazepine assay is free from interference of both hydroxyzine and cetirizine.

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Section: Discussionmentioning

confidence: 75%

Section: Resultsmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

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Hydroxyzine and Cetirizine Interfere With the PENTINA Carbamazepine Assay but Not With the ADVIA CENTEUR Carbamazepine Assay

Dasgupta¹,

Tso²,

Johnson³

et al. 2010

Therapeutic Drug Monitoring

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“…The boy survived the episode. 14 Parant reported two cases where hydroxyzine in serum caused false positive carbamazepine levels using the PENTINA assay. A 22-year-old female with a hydroxyzine concentration of 1.8 mg/mL and cetirizine concentration of 2.1 mg/mL showed an apparent carbamazepine level of 5.3 mg/mL.…”

Section: Discussionmentioning

confidence: 99%

False-positive Serum Tricyclic Antidepressant Concentrations Using Fluorescence Polarization Immunoassay Due to the Presence of Hydroxyzine and Cetirizine

Dasgupta¹,

Wells

Datta

2007

Therapeutic Drug Monitoring

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A recent report indicates that hydroxyzine and its active metabolite cetirizine interfere with the PENTINA carbamazepine assay. The potential interference of hydroxyzine and cetirizine with the fluorescence polarization immunoassay (FPIA) and CEDIA assay of carbamazepine as well as with the fluorescence polarization immunoassay of tricyclic antidepressants (TCA) was studied. Aliquots of drug-free serum pools were supplemented with various concentrations of hydroxyzine and cetirizine representing therapeutic, mild to moderate toxic as well as very toxic concentrations. Then apparent carbamazepine and TCA concentrations were measured by immunoassays. Although no interference of hydroxyzine and cetirizine was observed with carbamazepine assays (FPIA and CEDIA), significant apparent TCA concentrations were observed when aliquots of drug-free serum were supplemented with hydroxyzine or cetirizine. Mathematical formula was devised to predict hydroxyzine and/or cetirizine concentration in serum based on observed apparent TCA levels. Hydroxyzine and cetirizine also falsely increased total TCA values when aliquots of serum pool prepared from patients receiving TCA were further supplemented with these drugs. In conclusion, hydroxyzine and cetirizine do not interfere with the FPIA and CEDIA carbamazepine assays but interfere with the measurement of total TCA using the FPIA.

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“…No cardiovascular effects were noted and patients experienced only sedation 35,36 and, in one case, agitation. 37 All children underwent conservative management and suffered no sequelae.…”

Section: Pharmacology and Pathophysiologymentioning

confidence: 99%

New Oral Antihistamines in Pediatrics

Horowitz¹,

Reynolds²

2004

Pediatric Emergency Care

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This CME activity is intended for physicians, medical students, nurse practitioners, and physician assistants who manage children with acute illness in either the emergency department (ED) or office-based settings. Pediatric emergency physicians, emergency physicians, pediatricians, and family practitioners will find this information especially useful. LEARNING OBJECTIVESAfter completion of the article, the reader should be able to: 1. Discuss the role histamine plays in allergic responses. 2. Describe differences between first-and second-generation antihistamines based on pharmacology and side effect profiles. 3. Identify the second-generation antihistamines and their relative strengths and weaknesses.

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Cetirizine overdose in a young child

Cited by 38 publications

References 1 publication

Hydroxyzine and Cetirizine Interfere With the PENTINA Carbamazepine Assay but Not With the ADVIA CENTEUR Carbamazepine Assay

Hydroxyzine and Cetirizine Interfere With the PENTINA Carbamazepine Assay but Not With the ADVIA CENTEUR Carbamazepine Assay

False-positive Serum Tricyclic Antidepressant Concentrations Using Fluorescence Polarization Immunoassay Due to the Presence of Hydroxyzine and Cetirizine

New Oral Antihistamines in Pediatrics

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