Alzheimers Drug Is Poisonous to Infants

July 20, 2005 -- It's a basic child safety rule: Keep prescription drugs and other potential poisons out of children's reach.

Take the case of an 11-month-old girl from New England. She had "pesticide-like poisoning" after chewing on her grandmother's capsules of Exelon, an Alzheimer's drug.

The girl recovered and was sent home within 28 hours, doctors report in The New England Journal of Medicine.

Finding the Problem

The girl's family was Vietnamese. They took her to the hospital after she rapidly became weak over several hours.

A battery of tests didn't pinpoint the reason for her weakness.

The girl had been basically healthy, although she had been discharged from the same hospital three days earlier after being rehydrated for a stomach bug.

Doctors asked more questions. Were there plants in the home? What about poisons to keep rodents away?

The answer to both questions was "No." Exposure to outdoor insecticides was ruled out, since it was the middle of winter.

The Crucial Clue

The girl's mother had the most important clue. She had found her daughter chewing on her grandmother's Exelon capsules earlier in the day, before falling ill.

Due to language problems and history-taking, the connection between the drug exposure and the girl's symptoms weren't made right away, write Melisa Lai, MD, and colleagues.

Lai works at Children's Hospital in Boston.

Doctor's Note

Obviously, the baby girl wasn't supposed to take the drug.

Exelon is used to treat Alzheimer's disease to help improve memory and thinking.

Like other Alzheimer's drugs, Exelon is thought to help improve memory by increasing levels of a brain chemical called acetylcholine. This chemical is thought to play a critical role in memory, attention, and learning.

Many pesticides also act on this pathway in the brain when accidentally ingested.

The girl's symptoms were similar to symptoms from pesticide poisoning -- weakness and abnormalities such as lack of reflexes on doctor's exam.

Elderly patients taking Exelon and similar drugs rarely have these side effects unless they overdose on the medication.

"As use of this class of drugs becomes more widespread, we want to alert clinicians to consider such exposure when evaluating weakness of rapid onset or any case of pesticide-like poisoning in which pesticide exposure in unlikely," they write.

Lai's team didn't study Exelon (or similar drugs). They just describe the baby girl's case.

Drug Company's Comments

KB120 contacted Exelon's maker, Novartis, a KB120 sponsor, for comment.

Novartis spokesman Harry Rohme says the girl's case had not been reported to the company.

"But it will now be included in our database and submitted to the FDA," Rohme tells KB120. "The company recommends very strongly that all medications be kept out of the reach of children and in be kept in the child-proof containers in which they are dispensed," says Rohme.

"Be vigilant to ensure where elderly patients and infants are in the same household that children don't get access to the medications," he continues.