Reactions 819 - 16 Sep 2000

O SCitalopram overdose

Sinus bradycardia, hypotension and syncope: casereport

A 32-year-old woman developed sinus bradycardia,hypotension and episodes of syncope after taking an overdoseof citalopram in a suicide attempt.

The woman, who had a history of borderline personalitydisorder, attempted suicide by ingesting 20 citalopram 40mgtablets with a total dose of 800mg, > 10 times therecommended maximum therapeutic daily dosage. An hourlater, she was found in a stuporous state with a Glasgow comascore of 11. Her creatine kinase level was 530 IU/L and she hadmild hypokalaemia. She was treated with gastric lavage andactivated charcoal. Four hours after ingesting citalopram, herHR had decreased from 69 to 41 beats/min. Atropine was alsoadministered, but it was ineffective. She subsequentlydeveloped severe hypotension and intermittent episodes ofsyncope and a temporary pacemaker was inserted.

During the next 4 days, the woman’s pacemaker wasrepeatedly activated when her HR fell below 45 beats/min. Hermean pulse rate up to the sixth day of treatment was 50beats/min. On the seventh day, an ECG showed sinus rhythmwith a HR of 68 beats/min and the pacemaker was removed.She was subsequently admitted to a psychiatric hospital, fromwhich she was discharged 4 days later with no cardiovascularabnormalities.

Author comment: Several cases of pure citalopram overdosehave previously been reported. However, ‘to our knowledge,this is the first case report of pure citalopram overdose-inducedlong-lasting sinus bradycardia associated with severehypotension and intermittent syncopes that required therapywith a temporary pacemaker.’Rothenhausler H-B, et al. Suicide attempt by pure citalopram overdose causinglong-lasting severe sinus bradycardia, hypotension and syncopes: successfultherapy with a temporary pacemaker. Pharmacopsychiatry 33: 150-152, Jul 2000 -Germany 800842004

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Reactions 16 Sep 2000 No. 8190114-9954/10/0819-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved