Citalopram intoxication in four week old infant
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CASE REPORT
Open Access
Citalopram intoxication in four week old infant Jo-Anne Janson1, Arthur T. M. Wasylewicz2, Marianne Eijkemans3*
and Marieke Kerskes2
Abstract Background: In contrast to intoxications in toddlers which can be due to accidental ingestions, many intoxications in infants are due to medication errors. To our knowledge, this is the first case report of a citalopram intoxication in an infant, and may offer new insight on possible screening methods for intoxication as well as pharmacokinetics of citalopram in small infants. Case presentation: This case report describes an unintentional citalopram intoxication in a 4 week old infant due to a vitamin D drops ‘look alike’ error. The infant showed extreme jitteriness and opisthotonus at presentation, as well as prolonged signs of gastro-oesophageal reflux. No cardiac rhythm disturbances or convulsions were seen. The clinical course combined with Finnegan scores was correlated to and supported by pharmacokinetic and pharmacokinetic data of citalopram in the patient. Conclusions: Using Finnegan scores in general pediatric practice could help objectify follow-up of acute intoxications in young infants with neurological symptoms. Keywords: Citalopram, SSRI, Infant, Intoxication, Finnegan scores
Background Citalopram is the second most commonly used antidepressant in the world [1]. Citalopram is used in treating depression in pregnant as well as postpartum women, and is the most used antidepressant in pregnancy [1–3]. Citalopram is a selective serotonin reuptake inhibitor (SSRI), it works by inhibiting the central nervous system (CNS) reuptake of serotonin (5-HT) and the potentiation of serotonergic activity. Citalopram intoxication in adults is usually mild, consisting of symptoms of nausea, dizziness, tremors and somnolence, nevertheless significant toxicity can occur [4]. In children however, it has been defined as the most hazardous intoxication of all SSRIs, with seizures occurring four times more frequent that other SSRI’s, as well as
cardiotoxic effects, which occur more than three times as much [5]. In contrast to intoxications in toddlers which are often due to accidental ingestions, many intoxications in infants are due to medication errors [6]. Common medication errors which can occur in a ‘home’ situation are often due to ‘look-alike, sound-alike’ drug names and packaging [7]. In this case report, we describe an infant that was given his mother’s citalopram drops instead of its vitamin D drops, which are recommended to prevent rickets [8]. Little is known about the toxicity or kinetics of citalopram in infants [5]. To our knowledge, this is first case report of a citalopram intoxication in an infant, and may offer new insight on possible screening methods for intoxication as well as some insight into the pharmacokinetics of citalopram in small infants.
* Correspondence: [email protected] 3 Pediatrics, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands Full list of author information is availa
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