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Accidental clozapine intoxication in a toddler: clinical and pharmacokinetic lessons learnt

N Toepfner1, A Wohlfarth, J Naue

  • 1Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Carl Gustav Carus University, Dresden, Germany. nicole.toepfner@uniklinikum-dresden.de

Journal of Clinical Pharmacy and Therapeutics
|November 22, 2012
PubMed

Insights

Accidental clozapine ingestion in a 13-month-old toddler led to coma. Standard drug screens missed it, but LC-MS/MS confirmed clozapine, highlighting diagnostic challenges and lower toxic dose in young children.

Area of Science:

  • Pediatric Toxicology
  • Pharmacology
  • Clinical Chemistry

Background:

  • Clozapine, a second-generation antipsychotic, is increasingly prescribed in adults.
  • Therapeutic use in children is controversial, yet accidental pediatric ingestions are rising.
  • This report details the youngest known case of accidental clozapine ingestion.

Observation:

  • A 13-month-old girl presented with unexplained coma and respiratory insufficiency.
  • Initial toxicology screening via immunoassay was negative.
  • Liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) detected clozapine at 736 ng/mL.

Findings:

  • LC-MS/MS is crucial for diagnosing clozapine toxicity when immunoassays fail.
  • Clozapine metabolites (norclozapine, clozapine-N-oxide) are detectable longer, especially in urine.
  • The elimination pattern in toddlers resembles adults, with a lower toxic dose observed.

Implications:

  • Highlights limitations of standard toxicological screening in pediatric cases.
  • Underscores the need for advanced testing in suspected intoxications.
  • Informs clinical management and forensic investigations of clozapine exposure in young children.
Abstract

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