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Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children.
Clin Toxicol (Phila). 2012 Jun; 50(5):418-23.CT

Abstract

CONTEXT

In adults, citalopram is more likely to cause seizures and ECG changes than other selective serotonin reuptake inhibitors (SSRIs). Data in children are lacking, yet the 2007 American Association of Poison Control Centers out-of-hospital citalopram consensus guideline mirrors the guideline for other SSRIs.

OBJECTIVE

To compare the clinical effects and hazard index of citalopram with other SSRIs in pediatric ingestions.

METHODS

An 11-year retrospective analysis of national poison center data was conducted. Acute, known-type SSRI ingestions in children younger than 6 years with known outcome were included. Clinical effects and hazard index (number of major or fatal outcomes/1000 SSRI ingestions) were compared. Citalopram dose-response was evaluated.

RESULTS

The 35 296 included cases by SSRI type were citalopram (3747), escitalopram (4815), fluoxetine (5946), fluvoxamine (273), paroxetine (7157), and sertraline (13 358). The overall hazard index was 0.340. The hazard index for citalopram (0.801) was 2.8-fold higher than for non-citalopram SSRIs (0.285). Comparing seizures (single or multiple discrete) and cardiac effects (conduction disturbances, other ECG changes or other dysrhythmia) of citalopram with the other SSRIs, pediatric citalopram ingestions were more likely to develop seizures (5 of 3747 [0.13%] vs. 10 of 31 549 [0.03%], OR = 4.2; 1.4-12.3) and cardiac toxicity (9 of 3747 [0.24%] vs. 25 of 31 549 [0.08%], OR = 3.0; 1.4-6.5). Clinical effects occurring more frequently with other SSRIs included tachycardia (p = 0.0236), oral irritation (p = 0.0412), vomiting (p = 0.0036), agitation/irritability (p = 0.0104), and hyperthermia (p = 0.0314). There was a dose response only for single or multiple discrete seizures, mydriasis and clinically significant responses (a predetermined subset of CNS and cardiopulmonary clinical effects). Meaningful triage thresholds for citalopram could not be determined due to the low frequency of significant clinical effects.

CONCLUSION

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.

Authors+Show Affiliations

Maryland Poison Center, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA. wkleinsc@rx.umaryland.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22506805

Citation

Klein-Schwartz, Wendy, et al. "Comparison of Citalopram and Other Selective Serotonin Reuptake Inhibitor Ingestions in Children." Clinical Toxicology (Philadelphia, Pa.), vol. 50, no. 5, 2012, pp. 418-23.
Klein-Schwartz W, Benson BE, Lee SC, et al. Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children. Clin Toxicol (Phila). 2012;50(5):418-23.
Klein-Schwartz, W., Benson, B. E., Lee, S. C., & Litovitz, T. (2012). Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children. Clinical Toxicology (Philadelphia, Pa.), 50(5), 418-23. https://doi.org/10.3109/15563650.2012.678497
Klein-Schwartz W, et al. Comparison of Citalopram and Other Selective Serotonin Reuptake Inhibitor Ingestions in Children. Clin Toxicol (Phila). 2012;50(5):418-23. PubMed PMID: 22506805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children. AU - Klein-Schwartz,Wendy, AU - Benson,Blaine E, AU - Lee,Samantha C, AU - Litovitz,Toby, Y1 - 2012/04/16/ PY - 2012/4/18/entrez PY - 2012/4/18/pubmed PY - 2012/7/6/medline SP - 418 EP - 23 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 50 IS - 5 N2 - CONTEXT: In adults, citalopram is more likely to cause seizures and ECG changes than other selective serotonin reuptake inhibitors (SSRIs). Data in children are lacking, yet the 2007 American Association of Poison Control Centers out-of-hospital citalopram consensus guideline mirrors the guideline for other SSRIs. OBJECTIVE: To compare the clinical effects and hazard index of citalopram with other SSRIs in pediatric ingestions. METHODS: An 11-year retrospective analysis of national poison center data was conducted. Acute, known-type SSRI ingestions in children younger than 6 years with known outcome were included. Clinical effects and hazard index (number of major or fatal outcomes/1000 SSRI ingestions) were compared. Citalopram dose-response was evaluated. RESULTS: The 35 296 included cases by SSRI type were citalopram (3747), escitalopram (4815), fluoxetine (5946), fluvoxamine (273), paroxetine (7157), and sertraline (13 358). The overall hazard index was 0.340. The hazard index for citalopram (0.801) was 2.8-fold higher than for non-citalopram SSRIs (0.285). Comparing seizures (single or multiple discrete) and cardiac effects (conduction disturbances, other ECG changes or other dysrhythmia) of citalopram with the other SSRIs, pediatric citalopram ingestions were more likely to develop seizures (5 of 3747 [0.13%] vs. 10 of 31 549 [0.03%], OR = 4.2; 1.4-12.3) and cardiac toxicity (9 of 3747 [0.24%] vs. 25 of 31 549 [0.08%], OR = 3.0; 1.4-6.5). Clinical effects occurring more frequently with other SSRIs included tachycardia (p = 0.0236), oral irritation (p = 0.0412), vomiting (p = 0.0036), agitation/irritability (p = 0.0104), and hyperthermia (p = 0.0314). There was a dose response only for single or multiple discrete seizures, mydriasis and clinically significant responses (a predetermined subset of CNS and cardiopulmonary clinical effects). Meaningful triage thresholds for citalopram could not be determined due to the low frequency of significant clinical effects. CONCLUSION: 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. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/22506805/Comparison_of_citalopram_and_other_selective_serotonin_reuptake_inhibitor_ingestions_in_children_ L2 - https://www.tandfonline.com/doi/full/10.3109/15563650.2012.678497 DB - PRIME DP - Unbound Medicine ER -