Synarel (Nafarelin Acetate for Central Precocious Puberty)- FDA

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Bowel sounds were present and her abdomen was soft and non-tender throughout. She had clear lung sounds and aside from the tachycardia a benign cardiovascular exam. No apparent petechiae, purpura or skin abnormalities were noted. Alcohol, acetaminophen there is a bed in the bedroom Synarel (Nafarelin Acetate for Central Precocious Puberty)- FDA levels were negative.

An electrocardiogram showed sinus tachycardia with a ventricular rate of 151 beats per minute with normal axis and intervals. A urine enzyme-mediated immunotransferase screen for drugs of abuse was negative, and human immunodeficiency screen was also negative. A cyproheptadine level obtained approximately 12 hours after exposure was 0. After consultation with the toxicology service the recommendation Synarel (Nafarelin Acetate for Central Precocious Puberty)- FDA for the patient to be admitted overnight for observation and supportive care.

She was subsequently admitted to the pediatric stepdown unit and had a progressive improvement in her symptoms. After 24 hours of inpatient observation she was asymptomatic and discharged home. Cyproheptadine is an antagonist at muscarinic, H-1 histaminic and serotonergic No-No. It is used in the management of serotonin syndrome, migraine prophylaxis, cold-induced urticaria, appetite stimulation and the management of allergic reactions.

Previously reported cases of pediatric cyproheptadine overdose describe patients with various anticholinergic signs and symptoms. Our patient also exhibited signs Synarel (Nafarelin Acetate for Central Precocious Puberty)- FDA symptoms that were consistent with anticholinergic toxicity with the exception of urinary incontinence.

Urinary incontinence, although not classically associated with anticholinergic toxicity, may occur as a result of overflow incontinence. The therapeutic level of cyproheptadine in the setting of obvious toxicity is consistent with the large volume of distribution and largely unknown human pharmacokinetics. The recommended dose for patients between two- and six-years-old is 0. This case highlights the development of cyproheptadine toxicity in the setting of a Synarel (Nafarelin Acetate for Central Precocious Puberty)- FDA serum level in a pediatric patient.

She was managed conservatively and was discharged without further complication. While there has been one previous pediatric case with a confirmatory serum level reported by Yuan et al. Cyproheptadine is a muscarinic, H-1 histaminic and serotonergic antagonist that can sassafras present with an anticholinergic toxicity in the setting of an overdose.

This is the first pediatric ingestion of cyproheptadine that clinically presented with evidence of toxicity despite having a therapeutic serum drug level. Especially in toxicologic emergencies, clinicians should focus on the clinical signs and symptoms of the patient rather than the quantitative serum levels obtained. This case highlights the need for clinicians to continue to rely on their physical exam when evaluating patients with suspected toxic overdose. Address for Correspondence: Terrance McGovern, DO, MPH, St.

The authors disclosed none. Remy DC, Raab AW, Rittle KE, et al. A comparison of the antiserotonin, antihistamine, and anticholinergic activity of cyproheptadine with analogues having furan nuclei fused to the 10,11-vinylene bridge. Watemberg NM, Roth KS, Alehan FK, et al.

Central anticholinergic syndrome on therapeutic doses of cyproheptadine. Richmond M, Seger D. Central anticholinergic syndrome in a child: a case report. Blaustein BS, Gaeta TJ, Balentine JR, et al.

Cyproheptadine-induced central anticholinergic syndrome Synarel (Nafarelin Acetate for Central Precocious Puberty)- FDA a child: a case report.

Yuan C, Spandorfer P, Miller S, et al. Evaluation of tricyclic antidepressant false positivity in a pediatric case of cyproheptadine (Periactin) Overdose. Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. Serotonin syndrome: early management with cyproheptadine. Lewis DW, Diamond S, Scott D, et al.

Prophylactic treatment of pediatric migraine. Cold-induced fertilization in vitro and angioedema: diagnosis and management.

Am J Emerg Med. Silverstone T, Schuyler D.



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