Reactions 1093 - 18 Mar 2006

O SAmitriptyline/clomipramine/fluoxetineoverdose

Various toxicities: case reportA 40-year-old woman with postpartum depression

developed various toxicities following intentional overdose ofclomipramine, fluoxetine and controlled-release amitriptyline.

The woman took approximately 100 controlled-releaseamitriptyline [Lentizol] 50mg, 13 clomipramine 50mg and20 fluoxetine 20mg tablets. Fifteen hours later, she was notedto be drowsy and confused with presumed ethanolintoxication. On presentation approximately 1 hour later, shehad a HR of 105 beats/min, a BP of 125/65mm Hg and a pH of7.29. Her pupils were dilated and reactive, and her skin waswarm and dry. She had a Glasgow Coma Score of 7/15. ECGshowed sinus tachycardia, with a QRS duration of 119 msecs.Soon after presentation, she experienced a tonic-clonicseizure.

The woman received IV lorazepam. IV sodium bicarbonatewas administered for ventricular tachycardia. She wastransferred to the ICU following intubation and ventilation.Her serum concentrations of nortriptyline and clomipraminewere 970 ng/mL and 0.13 mg/L, respectively; fluoxetinetoxicology screen was negative. At 17.5 hours post ingestion,she had a serum amitriptyline concentration of 1100 ng/mL,which peaked at 2100 ng/mL at 42 hours, and decreased to1330 ng/mL at 70 hours. Evidence of amitriptyline toxicitycontinued and metabolic acidosis and QRS prolongationdeveloped; activated charcoal was administered at 34, 42 and48 hours. On day 4 she was extubated, and discharged onday 9 following psychiatric review.O’Connor N, et al. Prolonged clinical effects in modified-release amitriptylinepoisoning. Clinical Toxicology 44: 77-80, No. 1, 2006 - England 801036603

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Reactions 18 Mar 2006 No. 10930114-9954/10/1093-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved