Doxepin toxicity in a child following topical administration

OBJECTIVE: To describe a case of a child with altered mental status followi ng the topical administration of doxepin. CASE SUMMARY: A five-year-old Hispanic girl was brought tb the emergency de partment because she was difficult to arouse at school. She had recently de veloped a generalized eczematous rash for which she. was prescribed doxepin hydrochloride 5% cream. An entire tube (30 g) of doxepin dream was applied in the 24 hours prior to presentation. The patient was responsive only to noxious stimuli, with no focal neurologic abnormalities. She was decontamin ated and observed in a pediatric intensive care unit. By 18 hours after pre sentation, she had fully recovered and was discharged. CONCLUSIONS: Topical doxepin, available as a 5% cream, is indicated for the treatment of pruritus secondary to eczematous dermatoses in adults. Dimini shed skin integrity and the application of a massive quantity of doxepin 5% cream to a large body surface area contributed to the toxicity in this chi ld. Since the safety and efficacy of doxepin cream has not been established in children younger than 12 years, it should be used with caution in this population.