Reactions 654 - 7 Jun 1997

★ SCitalopram overdose

Seizures, heart disorders, hypokalaemia and firstreport of rhabdomyolysis: 5 case reports

Three men and 2 women, aged 26–44 years, intentionallyingested from 1440–5200mg of citalopram in suicideattempts. Four of the patients developed generalised seizuresand received treatment with diazepam. All patients hadprolonged QT intervals, 4 patients had sinus tachycardia and 3had inferolateral repolarisation disturbances.

The highest measured serum citalopram concentrationswere about 40–350 times higher than those observed inpatients taking citalopram 20 mg/day. The patient with thehighest citalopram concentration developed hypokalaemiaand 2 patients developed rhabdomyolysis.

The patients were treated on admission with gastric lavageand activated charcoal. Electrocardiographic and biochemicalabnormalities gradually returned to normal and all patientsrecovered without adverse sequelae.

Author comment: ‘Both electrocardiographic andgeneralised seizures are characteristic of severe citalopramoverdose . . . Rhabdomyolysis has been described afterimipramine and moclobemide overdose, but, as far as we areaware, not after SSRI overdose.’Grundemar L, et al. Symptoms and signs of severe citalopram overdose. Lancet349: 1602, 31 May 1997 - Sweden 800535114

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Reactions 7 Jun 1997 No. 6540114-9954/10/0654-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved