Adverse Effects and Toxicity of the Atypical Antipsychotics: What Is Important for the Pediatric Emergency Medicine Practitioner?

Medications are being used with greater frequency to address pediatric mental health problems, and in recent years, atypical antipsychotic (AAP) prescriptions have increased more than any other class. Acute care practitioners must be aware of the pharmacology of AAPs and the conditions, on- and off-label, for which they are prescribed. This involves identifying and managing adverse effects that manifest both mentally and physically. Although “atypicality” confers a lower risk of movement adverse effects compared with conventional agents, children are more sensitive than adults to extrapyramidal reactions. Like adults, they also may present with toxic sedation, confusion, cardiovascular dysfunction, and metabolic derangements. Evaluation and management of these toxicities requires an index of suspicion, a careful symptom and medication history, physical examination, and targeted interventions. This review is designed to orient the emergency practitioner to the challenging task of recognizing and treating adverse effects related to acute and chronic AAP exposure in children.