title: Comparison of pediatric atypical antipsychotic exposures reported to U.S. poison centers.
abstract: BACKGROUND
  The rise in atypical antipsychotic prescribing increases the risk of pediatric exposures. Published studies in children are limited.
  
  
  OBJECTIVE
  The objectives are to evaluate national poison center data on atypical antipsychotic exposures in young children and compare toxicity amongst selected agents.
  
  
  METHODS
  A retrospective study of U.S. National Poison Data System single substance exposures, from 2005 to 2013, of five atypical antipsychotics in children <6 years old, followed to known outcome was performed. Data were evaluated for reason, clinical effects, management site and outcome.
  
  
  RESULTS
  There were 16,935 exposures included: 5018 aripiprazole, 1735 olanzapine, 3904 quetiapine, 4778 risperidone and 1500 ziprasidone. Median age was two years. Most common reason was unintentional-general (90.6%). Therapeutic error occurred more often with risperidone (19.9%). Clinical effects occurred in 59.4% of aripiprazole, 57.9% of olanzapine, 56.6% of ziprasidone, 40.1% of risperidone, and 29.3% of quetiapine. The most frequent were drowsiness/lethargy (35.6%), tachycardia (6.9%), agitation (4.0%), and ataxia (3.3%). Drowsiness/lethargy occurred most with aripiprazole (47.6%), ziprasidone (46.5%) and olanzapine (45.1%) and least with quetiapine (20.5%) and risperidone (28.6%). Tachycardia and agitation both occurred most often with olanzapine (11.4% and 12.7%, respectively). Management sites were non-health care facility (28.0%), treated/discharged from emergency department (48.9%), admitted - noncritical care (11.4%), critical care (9.5%), and other/unknown (2.2%). Admission was lowest for risperidone (13.9%) and quetiapine (11.9%) and highest for olanzapine (32.9%). Coded outcomes were no effect (53.3%), minor (33.7%), moderate (12.1%), major (0.9%) and no deaths. Moderate/major outcomes occurred most often with ziprasidone (20.5%) and olanzapine (19.0%) and least often with quetiapine (5.3%) and risperidone (10.9%).
  
  
  CONCLUSIONS
  Overall outcomes were favorable, with major toxicity in <1% of exposures. Risperidone and quetiapine exposures resulted in less toxicity. This finding may be attributed to higher frequency of therapeutic errors for risperidone but the reason for less toxicity with quetiapine is unclear.
authors.affiliation: a Maryland Poison Center, Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy , Baltimore , MD , USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Stassinos
authors.affiliation: a Maryland Poison Center, Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy , Baltimore , MD , USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Klein-Schwartz
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000506:poisoning*; D002675:Child, Preschool; D062787:Drug Overdose / Q000453:epidemiology*; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data*; D011039:Poison Control Centers; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: Second generation antipsychotics; children; poisoning; toxicity