Paroxetine (Paxil) overdose: a pediatric focus

Area of Science:

• Pharmacology
• Toxicology
• Pediatric Medicine

Background:

• Paroxetine (PAXIL), a selective serotonin reuptake inhibitor (SSRI), has a high toxic threshold in adults.
• Limited data exists on toxic threshold doses and manifestations of paroxetine in pediatric overdose cases.
• Understanding pediatric paroxetine toxicity is crucial for effective clinical management.

Purpose of the Study:

• To evaluate the toxic threshold doses and clinical manifestations of paroxetine exposures in pediatric patients.
• To compare the toxicity profile of paroxetine in children versus adults and other antidepressants.

Main Methods:

• Retrospective review of pediatric paroxetine exposures reported to a regional poison control center over 24 months.
• Data collected included patient age, paroxetine dosage, co-ingestants, symptoms, treatment, and outcomes.
• Analysis focused on paroxetine-alone ingestions and cases with concomitant medications.

Main Results:

• Thirty-five pediatric exposures were documented, with ages ranging from 10.5 months to 17 years.
• Children under 5 years ingesting up to 120 mg of paroxetine alone remained asymptomatic or had mild symptoms.
• Older children and adolescents with co-ingestants experienced symptoms consistent with the combined substances.

Conclusions:

• Paroxetine exhibits a high therapeutic index in pediatric overdose cases, with a lower likelihood of severe toxic manifestations compared to other antidepressants.
• Ingestions of 120 mg or less in young children (<5 years) resulted in favorable outcomes with basic supportive care.
• Further research is needed to establish more precise toxic thresholds for pediatric paroxetine exposures.