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Pediatric ingestion of vilazodone compared to other selective serotonin reuptake inhibitor medications
Jason L Russell1,2,3, Henry A Spiller1,2,3, Thiphalak Chounthirath1,4
1a Nationwide Children's Hospital , Columbus , OH , USA.
Insights
Pediatric vilazodone ingestion, unlike other SSRIs, leads to higher hospitalization rates and more severe outcomes in children under six. Current guidelines may not adequately address vilazodone exposures.
Area of Science:
- Pediatric Toxicology
- Pharmacovigilance
- Emergency Medicine
Background:
- Unintentional ingestion of selective serotonin reuptake inhibitors (SSRIs) is common in young children.
- Existing management guidelines are based on data showing low incidence of severe outcomes.
Purpose of the Study:
- To compare pediatric exposure outcomes between vilazodone and other SSRIs.
- To inform updated clinical management strategies for SSRI ingestions.
Main Methods:
- Retrospective analysis of pediatric SSRI exposures (<6 years) reported to the National Poison Data System (NPDS).
- Comparison of outcomes for vilazodone-only and polysubstance exposures versus other SSRIs.
Main Results:
- Vilazodone exposures, though less common, showed significantly higher healthcare facility admission rates (31.1% single, 53.3% polysubstance).
- Children exposed to vilazodone had increased odds of major/moderate outcomes (25.2% single, 35.6% polysubstance) and severe events like seizures and coma.
Conclusions:
- Vilazodone pediatric ingestions are associated with greater hospitalization and more severe clinical effects than other SSRIs.
- Current SSRI exposure management guidelines may be insufficient for vilazodone ingestions in this age group.
Background:
Unintentional ingestion of selective serotonin reuptake inhibitor (SSRI) medications is common amongst children <6 years of age. Current evidence-based management guidelines are based on a low incidence of significant medical outcomes in these children.
Objective:
To describe and compare outcomes of pediatric exposures to vilazodone with other SSRIs.
Methods:
A retrospective observational case series analysis of both single and polysubstance SSRI exposures amongst children <6 years old reported to the National Poison Data System (NPDS).
Results:
11,384 SSRI exposures in children <6 years of age reported to NPDS between January 2012 and June 2016 were assessed. Vilazodone only accounted for 5.9% of all exposures, but resulted in the highest proportion of health care facility admission compared to other SSRIs, both in single substance (165 of 531 (31.1%); OR 9.0 [7.3-11.2]) and polysubstance (57 of 107 (53.3%); OR 4.1 [2.7-6.2]) exposures. Children exposed to vilazodone also have higher odds of experiencing a major or moderate outcome in single (134 of 531 (25.2%); OR 20.5 [15.5-27.1]) and polysubstance (37 of 107 (35.6%); OR 5.9 [3.7-9.0]) exposures compared to other SSRIs. Several severe clinical outcomes, such as seizure and coma, were more common among the vilazodone exposures.
Conclusions:
Exposure to vilazodone in this age group results in an increased rate of hospitalization as well as more severe clinical effects as compared to other SSRIs. Current evidence-based SSRI exposure management guidelines may not be appropriate for the management of vilazodone ingestion in this age group.