Accidental Ingestion of Venlafaxine in a 9 Month Old Infant

Abstract

Venlafaxine is a serotonin/norepinephrine reuptake inhibitor approved for adults with depressive, panic, and anxiety disorders. The safety and efficacy of venlafaxine has not yet been adequately established in pediatric patients to allow approval although studies have been reported in children and adolescents with primarily attention-deficit hyperactivity disorder and depression. The intentional or unintentional use of venlafaxine in patients less than 3 years of age has not been extensively reported. OBJECTIVE: To report the adverse effects following the probable accidental ingestion of venlafaxine in a 9-month-old infant. CASE SUMMARY: The infant presented to the emergency department about 7 hours after a presumed ingestion of a single 150 mg venlafaxine extended-release capsule. His mother and grandmother described him as having a “drugged look”, trembling, shaking, pill-rolling with his tongue, dilated pupils, and other odd behaviors. Upon presentation to the emergency room, he was sedate, had dilated pupils, and had depressed mental status. His urine was positive for phencyclidine (PCP), but a confirmatory test could not be done due to mishandling of the specimen. He was admitted and observed throughout the night. He was acting and eating normally the following morning and was subsequently discharged in stable condition. CONCLUSIONS: There is minimal information regarding venlafaxine toxicity in infants and children but accidental ingestion may cause a variety of serotonergic, anticholinergic, and neuromuscular adverse effects, mental status changes, and autonomic instability. Supportive care is a reasonable treatment when symptoms are not severe.