Paroxetine (Paxil) overdose: a pediatric focus

The antidepressant paroxetine (PAXIL) was approved for use in 1993. Thus far, this selective serotonin reuptake inhibitor (SSRI) has shown a high threshold for the development of toxic manifestations in adult overdoses. However, the toxic threshold doses and profile of toxic manifestations for pediatric exposures has not been well-established. All pediatric paroxetine exposures reported at a certified regional poison information center over a 24-mo period were reviewed. The parameters evaluated included age, amount, co-ingestants, symptoms, treatment and outcome. Thirty-five pediatric paroxetine exposures were documented. Ages ranged from 10.5 mo to 17 y. Paroxetine alone accounted for 28 cases and 7 were with concomitant medications. Of the paroxetine-alone ingestants, 16 cases were in children < or = 5 y (mean age 2.4 y) with ingestant amounts ranging from 10-120 mg. All patients remained asymptomatic with or without gastrointestinal decontamination. The remainder of sole ingestant cases included 12 patients > or = 12 y (mean age 17.2 y) who ingested 100-800 mg (mean 292 mg). Most remained asymptomatic. There were 7 patients in the co-ingestant group > or = 13 y. Only 2 remained asymptomatic, but the symptoms reported were also consistent with the co-ingestants taken. Paroxetine is less sedating and has fewer cardiovascular effects than the tricyclic antidepressants, even in the pediatric population. The high therapeutic index is consistent with other SSRI's. In contrast to more toxic antidepressants in the pediatric group, paroxetine overdose patients are less likely to develop toxic manifestations. Ingestions of 120 mg or less in children < or = 5 y led to favorable outcomes following gastrointestinal decontamination and minimal supportive care. However, continued evaluation of paroxetine is essential to determine more specific toxic thresholds.