A fatal case of venlafaxine overdose

Bosse, George M.; Spiller, Henry A.; Collins, Aaron M.

doi:10.1007/bf03160945

Cited by 45 publications

(27 citation statements)

References 11 publications

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“…In a therapeutic drug monitoring (TDM) material the median M/P ratio of ODV/VEN was 3 (range 0. [6][7][8][9][10] and the corresponding ratios in postmortem cases were 0.2 and 1.0 in Groups B and C, respectively [49]. In the present study, the median M/P ratio was 0.4 in B cases and 1.27 in C cases.…”

Section: Discussionsupporting

confidence: 49%

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Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood

Kingbäck

Karlsson

Zackrisson

et al. 2012

Forensic Science International

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However, a substantial variation in the relationship between the S-and R-enantiomers of VEN and metabolites was evident (S/R ratios ranging from 0.23-17.6). In six cases, a low S/R VEN ratio (mean 0.5) was associated with a high S/R ODV ratio (mean 11.9). Genotyping showed that these individuals carried two inactive CYP2D6 genes indicating a poor metabolizer phenotype. From these data we conclude that enantioselective analysis of VEN and ODV can predict if a person is a poor metabolizer genotype/phenotype for CYP2D6. Knowledge of the relationship between the S-and R-enantiomers of this antidepressant drug and its active metabolite is also important since the enantiomers display different pharmacodynamic profiles.

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Section: Discussionsupporting

confidence: 49%

“…Overdoses with VEN have been associated with several adverse effects such as sedation, tachycardia, seizures, hypotension, hypertension and serotonin syndrome [7][8][9][10][11][12][13] and fatal overdoses have been reported for VEN alone or in combination with other compounds [14,15].…”

Section: Introductionmentioning

confidence: 99%

Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood

Kingbäck

Karlsson

Zackrisson

et al. 2012

Forensic Science International

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“…Howell and co-workers also found a high prevalence of mydriasis in patients who took venlafaxine in overdose [14]. Venlafaxine is known to be more toxic in overdose than other SSRIs due to its pro-convulsant activity as well as cardiac sodium channel blocking capacity [15,16]. This is the first comparison study between venlafaxine and the SSRIs to have investigated QT intervals.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Venlafaxine and SSRIs in Deliberate Self-poisoning

2010

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To compare the clinical features of deliberate selfpoisoning with venlafaxine and selective serotonin reuptake inhibitors (SSRIs) presenting to the emergency department of an Australian tertiary referral hospital. A retrospective cohort study comparing all 36 patients who presented with venlafaxine self-poisoning with 44 randomly selected patients with SSRI self-poisoning between 1997 and 2006. Patients who had overdosed on venlafaxine were older (mean age 37.4 versus 28.8 years, p≤0.001) and generally exhibited a higher degree of suicidal intent (p≤0.017). Median venlafaxine dose taken was 35 defined daily doses (DDDs) compared with SSRIs 19.4 DDDs. Those who ingested venlafaxine were more likely to become confused (25% versus 0%; p=0) and have mydriasis (19.4% versus 2%; p≤0.02), than those who took SSRIs. One patient from the venlafaxine group died. Compared with SSRI self-poisoners, patients who deliberately ingested venlafaxine were more likely to exhibit serious suicide intent. They were also more likely to be older, take a higher DDD of the drug, and have confusion and mydriasis. This has implications for management of severely depressed and suicidal patients.

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“…The delay in symptom onset of such duration after lithium self-poisoning was not observed before to our knowledge [1,3,6]. Neither was such prolonged delay observed after venlafaxine self-poisoning [12,14,17].…”

Section: Discussionmentioning

confidence: 84%

Lithium and venlafaxine poisoning — a case report

et al. 2013

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AbstractIn treatment of manic-depressive conditions long-term lithium therapy may be combined with an effective and relatively safe antidepressant venlafaxine. Combined overdose may increase the risk of early toxicity of both drugs and of delayed lithium intoxication, responding to symptomatic and renal replacement therapy. We present a patient with combined lithium and venlafaxine self-poisoning with nothing but delayed signs of lithium intoxication with the emphasis on early and late treatment. 41-year old woman attempted suicide by large amount of lithium and venlafaxine. On admission she was asymptomatic, but with increased serum lithium over 5mmol/L. After gastric lavage, active charcoal and laxative administration she was receiving IV fluids. After a delay of 63 hours she deteriorated acutely by disorientation, confusion, fasciculation and tremor and was readmitted to Intensive care unit. In spite serum lithium decreased to 2mmol/L clinical signs were attributed to delayed lithium intoxication. After symptomatic and renal replacement therapy the patient’s condition improved after few days. We conclude that decontamination procedures are effective in particular for venlafaxine poisoning. If increased serum lithium levels are noted renal replacement therapy may be started even in asymptomatic patients as delayed lithium intoxication is most likely after few days.

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A fatal case of venlafaxine overdose

Cited by 45 publications

References 11 publications

Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood

Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood

A Comparison of Venlafaxine and SSRIs in Deliberate Self-poisoning

Lithium and venlafaxine poisoning — a case report

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