title: Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children.
abstract: BACKGROUND
  In adults, citalopram is more likely to cause seizures and ECG changes than other selective serotonin reuptake inhibitors (SSRIs). Data in children are lacking, yet the 2007 American Association of Poison Control Centers out-of-hospital citalopram consensus guideline mirrors the guideline for other SSRIs.
  
  
  OBJECTIVE
  To compare the clinical effects and hazard index of citalopram with other SSRIs in pediatric ingestions.
  
  
  METHODS
  An 11-year retrospective analysis of national poison center data was conducted. Acute, known-type SSRI ingestions in children younger than 6 years with known outcome were included. Clinical effects and hazard index (number of major or fatal outcomes/1000 SSRI ingestions) were compared. Citalopram dose-response was evaluated.
  
  
  RESULTS
  The 35 296 included cases by SSRI type were citalopram (3747), escitalopram (4815), fluoxetine (5946), fluvoxamine (273), paroxetine (7157), and sertraline (13 358). The overall hazard index was 0.340. The hazard index for citalopram (0.801) was 2.8-fold higher than for non-citalopram SSRIs (0.285). Comparing seizures (single or multiple discrete) and cardiac effects (conduction disturbances, other ECG changes or other dysrhythmia) of citalopram with the other SSRIs, pediatric citalopram ingestions were more likely to develop seizures (5 of 3747 [0.13%] vs. 10 of 31 549 [0.03%], OR = 4.2; 1.4-12.3) and cardiac toxicity (9 of 3747 [0.24%] vs. 25 of 31 549 [0.08%], OR = 3.0; 1.4-6.5). Clinical effects occurring more frequently with other SSRIs included tachycardia (p = 0.0236), oral irritation (p = 0.0412), vomiting (p = 0.0036), agitation/irritability (p = 0.0104), and hyperthermia (p = 0.0314). There was a dose response only for single or multiple discrete seizures, mydriasis and clinically significant responses (a predetermined subset of CNS and cardiopulmonary clinical effects). Meaningful triage thresholds for citalopram could not be determined due to the low frequency of significant clinical effects.
  
  
  CONCLUSIONS
  Children develop minimal toxicity with SSRI ingestions. Seizures and ECG changes, while uncommon, occur more frequently with citalopram. Doses associated with significant outcomes suggest that the triage guideline for citalopram does not need to be modified.
authors.affiliation: Maryland Poison Center, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA. wkleinsc@rx.umaryland.edu
authors.forename: Wendy
authors.initials: W
authors.lastname: Klein-Schwartz
authors.forename: Blaine E
authors.initials: BE
authors.lastname: Benson
authors.forename: Samantha C
authors.initials: SC
authors.lastname: Lee
authors.forename: Toby
authors.initials: T
authors.lastname: Litovitz
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D015283:Citalopram / Q000008:administration & dosage / Q000506:poisoning*; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000506:poisoning*; D014218:Triage / Q000379:methods; D014481:United States / Q000453:epidemiology
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors