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High Content Screening Analysis to Evaluate the Toxicological Effects of Harmful and Potentially Harmful Constituents HPHC
Published on: May 10, 2016
Comparison of pediatric atypical antipsychotic exposures reported to U.S. poison centers
Gina Stassinos1, Wendy Klein-Schwartz1
1a Maryland Poison Center, Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy , Baltimore , MD , USA.
Insights
Pediatric exposures to atypical antipsychotics are rising, but serious toxicity is rare. Risperidone and quetiapine showed less toxicity in young children compared to other agents.
Area of Science:
- Pediatric Toxicology
- Pharmacovigilance
- Neuroscience
Background:
- Atypical antipsychotic prescribing is increasing, leading to more pediatric exposures.
- Limited published data exists on the effects of these exposures in children.
Purpose of the Study:
- To analyze national poison center data on atypical antipsychotic exposures in children under six.
- To compare the toxicity profiles of specific atypical antipsychotic agents in this population.
Main Methods:
- Retrospective analysis of U.S. National Poison Data System records (2005-2013).
- Included single-substance exposures of five atypical antipsychotics in children younger than six years.
- Evaluated exposure reason, clinical effects, management site, and outcomes.
Main Results:
- Over 16,000 exposures were analyzed, with aripiprazole, quetiapine, and risperidone being most common.
- Most exposures (90.6%) were unintentional; therapeutic errors were higher with risperidone.
- Clinical effects like drowsiness and tachycardia were frequent, but major toxicity occurred in less than 1% of cases.
- Risperidone and quetiapine exposures were associated with lower rates of significant toxicity and hospital admission.
Conclusions:
- Overall outcomes for pediatric atypical antipsychotic exposures are favorable, with low rates of severe toxicity.
- Risperidone and quetiapine appear to have a lower toxicity profile in young children compared to other agents studied.
- Further investigation is needed to understand the reasons for the observed differences in toxicity, particularly for quetiapine.
Context:
The rise in atypical antipsychotic prescribing increases the risk of pediatric exposures. Published studies in children are limited.
Objective:
The objectives are to evaluate national poison center data on atypical antipsychotic exposures in young children and compare toxicity amongst selected agents.
Materials And Methods:
A retrospective study of U.S. National Poison Data System single substance exposures, from 2005 to 2013, of five atypical antipsychotics in children <6 years old, followed to known outcome was performed. Data were evaluated for reason, clinical effects, management site and outcome.
Results:
There were 16,935 exposures included: 5018 aripiprazole, 1735 olanzapine, 3904 quetiapine, 4778 risperidone and 1500 ziprasidone. Median age was two years. Most common reason was unintentional-general (90.6%). Therapeutic error occurred more often with risperidone (19.9%). Clinical effects occurred in 59.4% of aripiprazole, 57.9% of olanzapine, 56.6% of ziprasidone, 40.1% of risperidone, and 29.3% of quetiapine. The most frequent were drowsiness/lethargy (35.6%), tachycardia (6.9%), agitation (4.0%), and ataxia (3.3%). Drowsiness/lethargy occurred most with aripiprazole (47.6%), ziprasidone (46.5%) and olanzapine (45.1%) and least with quetiapine (20.5%) and risperidone (28.6%). Tachycardia and agitation both occurred most often with olanzapine (11.4% and 12.7%, respectively). Management sites were non-health care facility (28.0%), treated/discharged from emergency department (48.9%), admitted - noncritical care (11.4%), critical care (9.5%), and other/unknown (2.2%). Admission was lowest for risperidone (13.9%) and quetiapine (11.9%) and highest for olanzapine (32.9%). Coded outcomes were no effect (53.3%), minor (33.7%), moderate (12.1%), major (0.9%) and no deaths. Moderate/major outcomes occurred most often with ziprasidone (20.5%) and olanzapine (19.0%) and least often with quetiapine (5.3%) and risperidone (10.9%).
Discussion And Conclusion:
Overall outcomes were favorable, with major toxicity in <1% of exposures. Risperidone and quetiapine exposures resulted in less toxicity. This finding may be attributed to higher frequency of therapeutic errors for risperidone but the reason for less toxicity with quetiapine is unclear.
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