Clinical Course and Toxicokinetic Data Following Isolated Citalopram Overdose in an Infant

Masullo, Lawrence N.; Miller, Michael A.; Baker, S. David; Bose, Sudip; Levsky, Marc E.

doi:10.1080/15563650500514525

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…In a similar case report, a 10 month old infant ingested an unknown amount of citalopram tablets, the initial plasma level (1 h after ingestion) was 1400 μg/l. [13] In contrast to our case, this infant developed seizures requiring anti-epileptic therapy, making it impossible to administer repeated doses of activated charcoal and laxative. While neurological symptoms dissipated during admission, the patient kept on showing signs of increased muscle tone and gastro-oesophageal reflux during several weeks.…”

Section: Discussioncontrasting

confidence: 92%

Citalopram intoxication in four week old infant

et al. 2020

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Background In contrast to intoxications in toddlers which can be due to accidental ingestions, many intoxications in infants are due to medication errors. To our knowledge, this is the first case report of a citalopram intoxication in an infant, and may offer new insight on possible screening methods for intoxication as well as pharmacokinetics of citalopram in small infants. Case presentation This case report describes an unintentional citalopram intoxication in a 4 week old infant due to a vitamin D drops ‘look alike’ error. The infant showed extreme jitteriness and opisthotonus at presentation, as well as prolonged signs of gastro-oesophageal reflux. No cardiac rhythm disturbances or convulsions were seen. The clinical course combined with Finnegan scores was correlated to and supported by pharmacokinetic and pharmacokinetic data of citalopram in the patient. Conclusions Using Finnegan scores in general pediatric practice could help objectify follow-up of acute intoxications in young infants with neurological symptoms.

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Section: Discussioncontrasting

confidence: 92%

Citalopram intoxication in four week old infant

et al. 2020

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“…Generalized seizures are recognized in 2 to 6% of patients who present to hospital after deliberate citalopram overdose [6, 7]. Onset of seizures may be within 1 h of ingestion or delayed for up to 13 h [8, 9]. They tend to be short‐lived, and may be terminated promptly by benzodiazepine administration [10].…”

Section: Introductionmentioning

confidence: 99%

“…They tend to be short‐lived, and may be terminated promptly by benzodiazepine administration [10]. Recurrent seizures have been described in a child despite administration of midazolam and fosphenytoin [8].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for generalized seizures after deliberate citalopram overdose

Waring

Gray

Graham

2008

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Citalopram is a common means of self‐poisoning in young adults. • Generalized seizures are a recognised complication after selective serotonin reuptake inhibitor overdose (including citalopram overdose). WHAT THIS STUDY ADDS • The minimum stated citalopram dose associated with seizures in the absence of co‐ingested drugs was 400 mg. • Co‐ingestion of a tricyclic antidepressant or venlafaxine confers a 15‐fold increased risk of seizures. AIMS Seizures are a recognized complication of citalopram overdose. The present study sought to establish risk factors for seizures in this high‐risk patient group, including stated dose ingested, co‐ingested drugs or ethanol, and electrolyte disturbances. METHODS A retrospective casenote review was carried out of patients who attended the Emergency Department due to citalopram overdose between January 2000 and July 2007 inclusive. Stepwise logistic regression analysis considered age, gender, stated citalopram dose, acute ethanol consumption, co‐ingested drugs, administration of activated charcoal, and hyponatraemia. RESULTS There were 241 patients (177 women), and the median (interquartile range) stated citalopram dose was 300 mg (200 to 600 mg). Generalized seizures occurred in 18 patients (7.5%). Logistic regression analysis found co‐ingested tricyclic antidepressants or venlafaxine predicted seizures with odds ratio = 15 (95% confidence interval 3, 75). In the absence of co‐ingested drugs, the minimum citalopram dose associated with seizures was 400 mg. Odds ratio for seizures = 1.1 (95% confidence interval 1.0, 1.2) for every 100 mg increment in citalopram dose. Seizures were associated with a greater need for invasive ventilatory support, higher creatine kinase activity, and prolonged hospital stay. CONCLUSIONS Generalized seizures are an important manifestation of citalopram toxicity, and cannot be explained solely by electrolyte disturbances or co‐ingestion of other drugs or ethanol. The strongest predictors of seizures in this patient series were ingestion of high citalopram dosages and co‐ingestion of drugs capable of lowering seizure threshold.

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