Reactions 1205 - 7 Jun 2008

O SCitalopram overdose

Citalopram intoxication: 26 case reportsTwenty-six patients aged between 13 and 85 years

developed citalopram intoxication following citalopramoverdose [specific dosages not stated]. Almost all patients tookan intentional citalopram overdose, but it was unknownwhether two of the patients took an intentional overdose.Citalopram was the sole ingested drug in three patients. In allother cases, benzodiazepines, antipsychotics,antidepressants, or alcohol were also ingested. Two patientsdied [specific patient information was only stated for these twopatients].

Patients ingested 200–4960mg of citalopram; the amount ofcitalopram ingested was unknown in six patients. Citalopramconcentrations ranged from 0.21 to 7.5 mg/L with a period of20 minutes to 8 hours between suspected ingestion time andfirst blood sampling. Fourteen patients were admitted to anICU and five patients required mechanical ventilation. Twopatients had impaired renal function and four patients hadelevated liver enzymes.

Seventeen patients received activated charcoal andlaxatives. Eleven patients required additional medical support.Four patients had unconsciousness from benzodiazepineingestion and received flumazenil. Four patients experiencedconvulsions and received diazepam. Two patients received IVacetylcysteine because of paracetamol [acetaminophen]intoxication. Three patients received antibacterials forinfection (one patient) or aspiration pneumonia (two patients).One patient received dopamine and magnesium. Within3 days, most patients recovered.

An 85-year-old man, who had type 2 diabetes mellitus,chronic obstructive pulmonary disease, sick sinus syndromeand a pulmonary artery aneurysm, ingested a citalopramoverdose and died of respiratory arrest [dosage and time toreaction onset not stated]. It was unclear whether he had takenan intentional overdose of citalopram.

A 35-year-old woman, who had previously used IV heroinand was on haemodialysis, ingested a citalopram overdose anddeveloped hypokalaemia and as a result experienced heartarrest [dosage and time to reaction onset not stated]. She wasresuscitated and diagnosed with postanoxic encephalopathy.She also developed sepsis due to Staphylococcus aureus anddied. It was unclear whether she had taken an intentionalcitalopram overdose.

Author comment: For the patients who died, "[i]t can bequestioned that they died as a direct cause of citalopramintoxication".Jimmink A, et al. Clinical toxicology of citalopram after acute intoxication withthe sole drug or in combination with other drugs: overview of 26 cases.Therapeutic Drug Monitoring 30: 365-371, No. 3, Jun 2008 -Netherlands 801111371

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Reactions 7 Jun 2008 No. 12050114-9954/10/1205-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved