Reactions 839 - 17 Feb 2001

★ O SCitalopram overdose

First report of neuroleptic malignant syndrome:case report

An overdose of citalopram was associated with neurolepticmalignant syndrome in a 20-year-old man.

The man ingested citalopram 1900mg in a suicide attempt.He became comatose within 3 hours and was hospitalised.Upon admission to hospital, he was unconscious and hiscorneal reflexes were absent. He developed a mild fever of37.5°C and mild rigidity of his neck, abdominal muscle andlimbs. He was treated with oxygen and mannitol. Two dayslater, chest swelling was noted and palpitation revealedcrepitations. Because of spontaneous pneumothorax, he wasintubated and a chest drainage tube and a right subclaviancatheter were inserted. Mechanical ventilation was started.

The man was extubated 4 days later with oxygen continuedvia a mask, but his rigidity increased. On hospital day 7, hisserum creatine kinase level was elevated at 1258 U/L, andneuroleptic malignant syndrome was suspected. Treatmentwith bromocriptine was initiated and he started to regainconsciousness with intermittent agitation 6 hours later. Hislevel of consciousness had returned to normal 24 hours afterreceiving bromocriptine and he became asymptomatic. Hewas discharged on hospital day 10.

Author comment: ‘NMS [neuroleptic malignant syndrome]may have occurred as a result of relative dopaminergic decreasedue to citalopram overdose’.Aydin N, et al. Neuroleptic malignant syndrome due to citalopram overdose.Canadian Journal of Psychiatry 45: 941-942, Dec 2000 - Turkey 800857754

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of neuroleptic malignantsyndrome associated with citalopram.

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Reactions 17 Feb 2001 No. 8390114-9954/10/0839-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved