Abstract
Ziprasidone is an atypical antipsychotic approved for the treatment of schizophrenia and bipolar mania in adults and is used off label in children and adolescents. Despite increasing use of ziprasidone in both adult and pediatric populations, there remains a paucity of reports describing unintentional pediatric exposures. The following report describes a patient with isolated ziprasidone ingestion who required intubation secondary to respiratory failure. A 15-month-old previously healthy boy presented to the emergency department shortly after his father found him with approximately five partially dissolved 80-mg ziprasidone tablets in his mouth. The child was flaccid and lethargic with no eye opening, withdrawing from pain only. Two hours after arrival, he developed worsening CNS depression with inability to protect his airway and underwent endotracheal intubation. A serum ziprasidone level was 330 ng/mL by LC/MS. The patient was extubated approximately 14 h later and was discharged from the hospital shortly thereafter in good health without neurological sequelae. Isolated pediatric ingestion of ziprasidone resulting in the need for significant medical intervention has not been previously reported. We report a case of respiratory failure requiring intubation following accidental ziprasidone ingestion with confirmatory serum levels.
Keywords: Ziprasidone, Ingestion, Respiratory failure, Toxicology
Full Text
The Full Text of this article is available as a PDF (69.1 KB).
References
- 1.Malone RP, Delaney MA, Hyman SB, et al. Ziprasidone in adolescents with autism: an open-label pilot study. J Child Adolesc Psychopharmacol. 2007;17(6):779–790. doi: 10.1089/cap.2006.0126. [DOI] [PubMed] [Google Scholar]
- 2.Biederman J, Mick E, Spencer T, et al. A prospective open-label treatment trial of ziprasidone monotherapy in children and adolescents with bipolar disorder. Bipolar Disord. 2007;9(8):888–894. doi: 10.1111/j.1399-5618.2007.00450.x. [DOI] [PubMed] [Google Scholar]
- 3.LoVecchio F, Watts D, Eckholdt P. Three-year experience with ziprasidone exposures [letter] Am J Emerg Med. 2004;23(4):586–587. doi: 10.1016/j.ajem.2004.09.033. [DOI] [PubMed] [Google Scholar]
- 4.Reilly TH, Kirk MA. Atypical antipsychotics and newer antidepressants. Emerg Med Clin North Am. 2007;25:477–497. doi: 10.1016/j.emc.2007.02.003. [DOI] [PubMed] [Google Scholar]
- 5.Lackey G, Alsop J, Albertson T. A one year review of pediatric ziprasidone ingestions [abstract] J Toxicol Clin Toxicol. 2002;40(5):624. [Google Scholar]
- 6.Bryant SM, Zilberstein J, Cumpston KL, et al. A case series of ziprasidone overdoses. Vet Hum Toxicol. 2003;45(2):81–82. [PubMed] [Google Scholar]
- 7.Biswas AK, Zabrocki LA, Mayes KL, et al. Cardiotoxicity associated with intentional ziprasidone and buproprion overdose. J Toxicol Clin Toxicol. 2003;41(2):101–104. doi: 10.1081/clt-120019121. [DOI] [PubMed] [Google Scholar]
- 8.Anita SX, Sholevar EH, Baron DA. Overdoses and ingestions of second-generation antipsychotics in children and adolescents. J Child Adolesc Psychopharmacol. 2005;15(6):970–985. doi: 10.1089/cap.2005.15.970. [DOI] [PubMed] [Google Scholar]
- 9.Teich J. Side effects of ziprasidone. Am J Psychiatry. 2003;160:1355–1356. doi: 10.1176/appi.ajp.160.7.1355-a. [DOI] [PubMed] [Google Scholar]
- 10.Klein-Schwartz W, Lofton AL, Benson BE, et al. Prospective observational multi-poison center study of ziprasidone exposures. J Toxicol Clin Toxicol. 2007;45:782–786. doi: 10.1080/15563650701639006. [DOI] [PubMed] [Google Scholar]
- 11.Sallee FR, Miceli JJ, Tensfeldt T, et al. Single-dose pharmacokinetics and safety of ziprasidone in children and adolescents. J Am Acad Child Adolesc Psych. 2006;45(6):720–728. doi: 10.1097/01.chi.0000215347.93902.3e. [DOI] [PubMed] [Google Scholar]
- 12.Isbister GK, Balit CR, Kilham HA. Antipsychotic poisoning in young children. A systematic review. Drug Saf. 2005;28(11):1029–1044. doi: 10.2165/00002018-200528110-00004. [DOI] [PubMed] [Google Scholar]
- 13.DuBoise D. Toxicology and overdose of atypical antipsychotic medications in children: does newer necessarily mean safer? Curr Opin Pediatr. 2005;17(2):227–233. doi: 10.1097/01.mop.0000151714.87702.a9. [DOI] [PubMed] [Google Scholar]
- 14.Lofton AL, Klein-Schwartz W, Spiller HA, et al. Prospective multi-center study of ziprasidone exposures [abstract] J Toxicol Clin Toxicol. 2004;42(5):726. [Google Scholar]
- 15.Forrester MB. Pattern of ziprasidone exposures reported to Texas poison centers, 2001–2005. Human Exp Toxicol. 2008;27(4):355–361. doi: 10.1177/0960327108091170. [DOI] [PubMed] [Google Scholar]
- 16.Geodon [package insert] (2007). Pfizer, New York