Reactions 959 - 12 Jul 2003

★ O SCitalopram overdose

First report of respiratory distress syndrome andrenal failure: case report

A 45-year-old man developed respiratory distress syndromeand renal failure after ingesting an overdose of citalopram in asuicide attempt.

The man ingested approximately 75 citalopram [‘Cipramil’]40mg tablets and, 2 hours later, presented to the emergencydepartment with a HR of 100 beats/min and a BP of 120/80mmHg; a chest x-ray showed bilateral basal shadowing. Shortlyafter arrival he had a brief self-terminating tonic-clonic seizure,then two further seizures terminated with IV diazepam. By 10hours post-ingestion he had a fever and had become oliguricwith deteriorating renal function. He became increasinglyhypoxic and started receiving continuous positive airwaypressure (CPAP), ventilation and broad spectrumantibacterials. Repeat chest x-ray showed bilateral diffusealveolar shadowing. By 24 hours post-ingestion he required100% oxygen and CPAP, and remained oliguric with risingserum creatinine and creatine kinase levels; his renal functionsubsequently spontaneously improved. He was extubated onday 10 but hypoxia persisted, with bilateral diffuse alveolarinfiltrates on chest x-ray. On day 5, Acinetobactercalcoaceticus was isolated from tracheal secretions. Maximumtotal citalopram concentration (1.92 mg/L) was seen 2 hourspost-ingestion with norcitalopram concentrations continuingto rise up to 24 hours post-ingestion. Plasma citalopramconcentrations also rose 18–24 hours post-ingestion. Hesubsequently recovered steadily and was transferred forongoing psychiatric care.

Author comment: "We suggest that citalopram may causerenal failure, in the absence of rhabdomyolysis, although theunderlying mechanism is unclear. We also suggest that highdoses of citalopram may cause acute lung injury and respiratoryfailure as seen with other antidepressants."Kelly CA, et al. Adult respiratory distress syndrome and renal failure associatedwith citalopram overdose. Human and Experimental Toxicology 22: 103-105, Feb2003 - Scotland 807213695

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of respiratory distresssyndrome or renal failure associated with citalopram. The WHOAdverse Drug Reactions database contained 114 reports ofdyspnoea and nine of acute renal failure associated withcitalopram.

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Reactions 12 Jul 2003 No. 9590114-9954/10/0959-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved