PAROXETINE (PAXIL) OVERDOSE - A PEDIATRIC FOCUS

The antidepressant paroxetine (PAXIL) was approved for use in 1993. Th us far, this selective serotonin reuptake inhibitor (SSRI) has shown a high threshold for the development of toxic manifestations in adult o verdoses. However, the toxic threshold doses and profile of toxic mani festations 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 ca ses and 7 were with concommitant medications. Of the paroxetine-alone ingestants, 16 cases were in children less than or equal to 5 y (mean age 2.4 y) with ingestant amounts ranging from 10-120 mg. All patients remained asymptomatic with or without gastrointestinal decontaminatio n. The remainder of sole ingestant cases included 12 patients greater than or equal to 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-i ngestant group greater than or equal to 13 y. Only 2 remained asymptom atic, but the symptoms reported were also consistent with the co-inges tants taken. Paroxetine is less sedating and has fewer cardiovascular effects than the tricyclic antidepressants, even in the pediatric popu lation. The high therapeutic index is consistent with other SSRI's. In contrast to more toxic antidepressants in the pediatric group, paroxe tine overdose patients are less likely to develop toxic manifestations . Ingestions of 120 mg or less in children less than or equal to 5 y l ed to favorable outcomes following gastrointestinal decontamination an d minimal supportive care. However, continued evaluation of paroxetine is essential to determine more specific toxic thresholds.