Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children

Abstract

Children develop minimal toxicity with SSRI ingestions. Seizures and ECG changes, while uncommon, occur more frequently with citalopram. Doses associated with significant outcomes suggest that the triage guideline for citalopram does not need to be modified.

Comparative safety of selective serotonin reuptake inhibitors among pediatric users with respect to adverse cardiac events

“…The increased risk of adverse outcome associated with citalopram and escitalopram in our study is consistent with prior case reports and comparative studies of antidepressant overdose . The single pediatric comparative study evaluating unintentional SSRI ingestions in children less than 6 years old found that citalopram ingestions were more likely to result in cardiovascular compromise than other SSRIs .…”

“…A provider initiating a pediatric patient on an SSRI needs to know which drug, if any, may have a greater risk of adverse cardiac events than another. Yet, there have been no pediatric‐focused studies examining the association between SSRI use and either prolonged QT or TdP outside of clear overdose situations or antenatal exposure . Therefore, given the paucity of pediatric data and the frequency with which SSRIs are prescribed for children and adolescents, we performed a comparative safety study examining the risk of ventricular arrhythmias, cardiac arrest, or sudden death (VA, CA, or SD) associated with SSRI use in pediatric population.…”

A Systematic Evaluation of the QTc Interval and Antidepressants in Youth

“…Krulewicz et al 4 found no significant increase in QTc in children prescribed paroxetine compared with placebo. KleinSchwartz et al 5 found only 3 noted QTc prolongations in the charts of 3747 children younger than 6 years who presented to the emergency department after ingesting citalopram.…”

Acute Vilazodone Toxicity in a Pediatric Patient

“…Our patient's clinical course was similar to these cases, exhibiting autonomic instability, lower extremity clonus, hypertonia, and altered mental status, with a history of ingestion of a serotonergic agent. Seizures have been described with ingestions of other SSRIs and occur more often with citalopram ingestions than other SSRI ingestions (7). Similar treatment strategies for other serotonergic medication ingestions, including benzodiazepines and cyproheptadine effectively controlled our patient's symptoms in the acute phase of illness (1,2).…”