Phenothiazine and butyrophenone intoxication in children

Area of Science:

• Pediatric Pharmacology
• Toxicology
• Neuroscience

Background:

• Antipsychotic agents are frequently prescribed for psychotic disorders.
• These medications are also used off-label for conditions like nausea, vomiting, and sedation.
• Children may experience antipsychotic drug toxicity from accidental ingestion or adverse effects.

Purpose of the Study:

• To review the clinical manifestations and management of antipsychotic drug toxicity in children.
• To emphasize the importance of recognizing diverse symptoms associated with phenothiazine and butyrophenone toxicity.
• To advise against the routine use of antipsychotics for non-psychotic indications in pediatric patients.

Main Methods:

• Literature review of antipsychotic agents, focusing on pediatric toxicity.
• Analysis of pharmacologic actions of phenothiazines and butyrophenones.
• Summary of treatment strategies for antipsychotic drug toxicity, including supportive care and specific interventions.

Main Results:

• Antipsychotic drug toxicity in children can manifest with a wide range of clinical signs and symptoms.
• Phenothiazines and butyrophenones possess diverse pharmacologic actions leading to complex presentations.
• Management involves general supportive care, monitoring, and targeted treatment for extrapyramidal syndromes and neuroleptic malignant syndrome.

Conclusions:

• Awareness of diverse antipsychotic toxicity manifestations aids in evaluating pediatric behavioral and neurologic issues.
• Routine use of antipsychotics for non-psychotic conditions in children is not recommended due to unpredictable toxicity.
• Clinicians must be vigilant for potential toxicity when prescribing or managing antipsychotic medications in pediatric populations.