Skip to main content
SpringerLink
Log in

Atypical antipsychotic poisoning in young children: a multicentre analysis of poisons centres data

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Although paediatric patients frequently suffer from intoxications with atypical antipsychotics, the number of studies in young children, which have assessed the effects of acute exposure to this class of drugs, is very limited. The aim of this study was to achieve a better characterization of the acute toxicity profile in young children of the atypical antipsychotics clozapine, olanzapine, quetiapine, and risperidone. We performed a multicentre retrospective analysis of cases with atypical antipsychotics intoxication in children younger than 6 years, reported by physicians to German, Austrian, and Swiss Poisons Centres for the 9-year period between January 1, 2001 and December 31, 2009. One hundred and six cases (31 clozapine, 29 olanzapine, 12 quetiapine, and 34 risperidone) were available for analysis. Forty-seven of the children showed minor, 28 moderate, and 2 severe symptoms. Twenty-nine cases were asymptomatic. No fatalities were recorded. Symptoms predominantly involved the central nervous and cardiovascular systems. Minor reduction in vigilance (Glasgow Coma Scale score >9) (62 %) was the most frequently reported symptom, followed by miosis (12 %) and mild tachycardia (10 %). Extrapyramidal motor symptoms were observed in one case (1 %) after ingestion of risperidone. In most cases, surveillance and supportive care were sufficient to achieve a good outcome, and all children made full recovery. Conclusions: Paediatric antipsychotic exposure can result in significant poisoning; however, in most cases only minor or moderate symptoms occurred and were followed by complete recovery. Symptomatic patients should be monitored for central nervous system depression and an electrocardiogram should be obtained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

Bpm:

beats per minute

CI:

confidence interval

ECG:

electrocardiogram

EPS:

extrapyramidal symptoms

GCS:

Glasgow Coma Scale

GfKT:

Society of Clinical Toxicology

HR:

heart rate

PSS:

Poisoning Severity Score

QTc:

QT interval corrected for heart rate

STIC:

Swiss Toxicological Information Centre

WHO:

World Health Organization

References

  1. Almandil NB, Wong IC (2011) Review on the current use of antipsychotic drugs in children and adolescents. Arch Dis Child Educ Pract Ed 96:192–196

    Article  PubMed  Google Scholar 

  2. Anderson M (2012) Poisoning in young children. Arch Dis Child 97:831–832

    Article  PubMed  Google Scholar 

  3. Antia SX, Sholevar EH, Baron DA (2005) Overdoses and ingestions of second-generation antipsychotics in children and adolescents. J Child Adolesc Psychopharmacol 15:970–985

    Article  PubMed  Google Scholar 

  4. Bond GR, Woodward RW, Ho M (2012) The growing impact of pediatric pharmaceutical poisoning. J Pediatr 160:265–270

    Article  PubMed  Google Scholar 

  5. Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC (2012) 2011 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol (Phila) 50:911–1164

    Article  Google Scholar 

  6. Budnitz DS, Salis S (2011) Preventing medication overdoses in young children: an opportunity for harm elimination. Pediatrics 127:1597–1599

    Article  Google Scholar 

  7. Burns MJ (2001) The pharmacology and toxicology of atypical antipsychotic agents. J Toxicol Clin Toxicol 39:1–14

    Article  CAS  PubMed  Google Scholar 

  8. Caccia S, Clavenna A, Bonati M (2011) Antipsychotic drug toxicology in children. Expert Opin Drug Metab Toxicol 7:591–608

    Article  CAS  PubMed  Google Scholar 

  9. Campbell M, Rapoport JL, Simpson GM (1999) Antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatry 38:537–545

    Article  CAS  PubMed  Google Scholar 

  10. Catalano G, Cooper DS, Catalano MC, Butera AS (1999) Olanzapine overdose in an 18-month-old child. J Child Adolesc Psychopharmacol 9:267–271

    Article  CAS  PubMed  Google Scholar 

  11. Chan A, Isbister GK, Kirkpatrick CM, Dufful SB (2007) Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogram. QJM 100:609–615

    Article  CAS  PubMed  Google Scholar 

  12. Cheng-Shannon J, McGough JJ, Pataki C, McCracken JT (2004) Second-generation antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol 14:372–394

    Article  PubMed  Google Scholar 

  13. Cobaugh DJ, Erdman AR, Booze LL, Scharman EJ, Christianson G, Manoguerra AS, Caravati EM, Chyka PA, Woolf AD, Nelson LS, Troutman WG (2007) Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 45:918–942

    Article  Google Scholar 

  14. Dubois D (2005) Toxicology and overdose of atypical antipsychotic medications in children: does newer necessarily mean safer? Curr Opin Pediatr 17:227–233

    Article  PubMed  Google Scholar 

  15. Eyer F, Pfab R, Felgenhauer N, Strubel T, Saugel B, Zilker T (2011) Clinical and analytical features of severe suicidal quetiapine overdoses–a retrospective cohort study. Clin Toxicol 49:846–853

    Article  CAS  Google Scholar 

  16. Findling RL, McNamara NK (2004) Atypical antipsychotics in the treatment of children and adolescents: clinical applications. J Clin Psychiatry 65(Suppl 6):30–44

    CAS  PubMed  Google Scholar 

  17. Findling RL, McNamara NK, Gracious BL (2000) Paediatric uses of atypical antipsychotics. Expert Opin Pharmacother 1:935–945

    Article  CAS  PubMed  Google Scholar 

  18. Fleischhaker C, Heiser P, Hennighausen K, Herpertz-Dahlmann B, Holtkamp K, Mehler-Wex C, Rauh R, Remschmidt H, Schulz E, Warnke A (2006) Clinical drug monitoring in child and adolescent psychiatry: side effects of atypical neuroleptics. J Child Adolesc Psychopharmacol 16:308–316

    Article  PubMed  Google Scholar 

  19. Hoffman RS (2007) Understanding the limitations of retrospective analyses of poison center data. Clin Toxicol (Phila) 45:943–945

    Article  Google Scholar 

  20. Isbister GK, Balit CR, Kilham HA (2005) Antipsychotic poisoning in young children: a systematic review. Drug saf 28:1029–1044

    Article  CAS  PubMed  Google Scholar 

  21. Liebelt EL (2005) New drug therapies for diseases in children: from atypical antipsychotics to antivenom for snakebites. Curr Opin Pediatr 17:221–222

    Article  PubMed  Google Scholar 

  22. McCaig LF, Burt CW (1999) Poisoning-related visits to emergency departments in the United States, 1993–1996. J Toxicol Clin Toxicol 37:817–826

    Article  CAS  PubMed  Google Scholar 

  23. McKinney C, Renk K (2011) Atypical antipsychotic medications in the management of disruptive behaviors in children: safety guidelines and recommendations. Clin Psychol Rev 31:465–471

    Article  PubMed  Google Scholar 

  24. Minns AB, Clark RF (2012) Toxicology and overdose of atypical antipsychotics. J Emerg Med 43:906–913

    Article  PubMed  Google Scholar 

  25. Moya J, Bearer CF, Etzel RA (2004) Children's behavior and physiology and how it affects exposure to environmental contaminants. Pediatrics 113(4 Suppl):996–1006

    PubMed  Google Scholar 

  26. Page CB, Calver LA, Isbister GK (2010) Risperidone overdose causes extrapyramidal effects but not cardiac toxicity. J Clin Psychopharmacol 30:387–390

    Article  CAS  PubMed  Google Scholar 

  27. Patel NC, Crismon ML, Hoagwood K, Johnsrud MT, Rascati KL, Wilson JP, Jensen PS (2005) Trends in the use of typical and atypical antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatry 44:548–556

    Article  PubMed  Google Scholar 

  28. Persson HE, Sjoberg GK, Haines JA, Pronczuk de Garbino J (1998) Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 36:205–213

    Article  CAS  PubMed  Google Scholar 

  29. R Core Team (2012) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. Available via http://www.R-project.org/. Accessed 15 January 2013

  30. Schillie SF, Shehab N, Thomas KE, Budnitz DS (2009) Medication overdoses leading to emergency department visits among children. Am J Prev Med 37:181–187

    Article  PubMed  Google Scholar 

  31. Stedtler U, Hoffmann-Walbeck P, Prasa D, Rauber-Luethy C, Reinecke HJ (2008) Amlodipine: collection and analysis of case data in the society of clinical toxicology of German speaking countries (GfKT). EAPCCT Abstracts Clin Toxicol (Phila) 46:351–421

    Article  Google Scholar 

  32. Stürer A, Felgenhauer N, Hentschel H, Hruby K, Seidel C, Lampe D, Kupferschmidt H (2013) Codex über die Zusammenarbeit und die Nutzung gemeinsamer Daten der Giftinformationszentren. Available via http://www.klinitox.de/fileadmin/DOKUMENTE/GESELLSCHAFT/GfKT_CODEX_v1.0_071108.pdf Accessed 15 January 2013

  33. Tan HH, Hoppe J, Heard K (2009) A systematic review of cardiovascular effects after atypical antipsychotic medication overdose. Am J Emerg Med 27:607–616

    Article  PubMed Central  PubMed  Google Scholar 

  34. The WHO Child Growth Standards. Available via http://www.who.int/childgrowth/standards Accessed 15 January 2013

  35. Vitiello B, Correll C, van Zwieten-Boot B, Zuddas A, Parellada M, Arango C (2009) Antipsychotics in children and adolescents: increasing use, evidence for efficacy and safety concerns. Eur Neuropsychopharmacol 19:629–635

    Article  CAS  PubMed  Google Scholar 

  36. Wong DC, Curtis LA (2004) Are 1 or 2 dangerous? Clozapine and olanzapine exposure in toddlers. J Emerg Med 27:273–277

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Science, Swiss Toxicological Information Centre, Associated Institute of the University of Zurich, Freiestrasse 16, Zurich, CH-8032, Switzerland

    Marianne Meli, Christine Rauber-Lüthy, Hugo Kupferschmidt & Alessandro Ceschi

  2. Berlin Poison Information Centre, Berlin, Germany

    Petra Hoffmann-Walbeck

  3. Mainz Poison Control Centre, Mainz, Germany

    Hans-Jürgen Reinecke

  4. Erfurt Poison Information Centre, Erfurt, Germany

    Dagmar Prasa

  5. Freiburg Poison Information Centre, Freiburg, Germany

    Uwe Stedtler

  6. North Poison Information Centre, Göttingen, Germany

    Elke Färber

  7. Wien Poison Information Centre, Vienna, Austria

    Dieter Genser

  8. Department of Clinical Pharmacology and Toxicology, Zurich University Hospital, Zurich, Switzerland

    Gerd A. Kullak-Ublick & Alessandro Ceschi

Authors
  1. Marianne Meli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Rauber-Lüthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Petra Hoffmann-Walbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans-Jürgen Reinecke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dagmar Prasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Uwe Stedtler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elke Färber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dieter Genser
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hugo Kupferschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gerd A. Kullak-Ublick
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alessandro Ceschi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Ceschi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meli, M., Rauber-Lüthy, C., Hoffmann-Walbeck, P. et al. Atypical antipsychotic poisoning in young children: a multicentre analysis of poisons centres data. Eur J Pediatr 173, 743–750 (2014). https://doi.org/10.1007/s00431-013-2241-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-013-2241-y

Keywords

Search

Navigation