Citalopram overdose and severe serotonin syndrome in an intermediate metabolizing patient

Schult, Rachel F.; Morris, Anna J.; Picard, Lindsey; Wiegand, Timothy J.

doi:10.1016/j.ajem.2019.06.038

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…One case reported moderate serotonin syndrome involving hyperreflexia and ankle clonus in an adult male on sertraline monotherapy [96]. Most other cases of serotonin syndrome with SSRI monotherapy have involved overdose or switching SSRI therapy without crosstitration [97][98][99]. To prevent serotonin syndrome in patients on SSRIs, providers should exercise caution when combining, switching, or discontinuing these drugs [100].…”

Section: Serotonin Syndromementioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Edinoff

Akuly

Hanna

et al. 2021

Neurology International

185

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Depression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population. Despite an array of treatment modalities, depressive disorders remain difficult to manage due to many factors. Beginning with the introduction of fluoxetine to the United States in 1988, selective serotonin reuptake inhibitors (SSRIs) quickly became a mainstay of treatment for a variety of psychiatric disorders. The primary mechanism of action of SSRIs is to inhibit presynaptic reuptake of serotonin at the serotonin transporter, subsequently increasing serotonin at the postsynaptic membrane in the serotonergic synapse. The six major SSRIs that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action. While their primary mechanism of action is similar, each SSRI has unique pharmacokinetics, pharmacodynamics, and side effect profile. One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18–24. There is a lack of understanding of the complexities and interactions between SSRIs in the developing brain of a young person with depression. Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality. Ultimately, when prescribing SSRIs to any patient, a risk–benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated. The aim of this review is to educate clinicians on potential adverse effects of SSRIs.

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Section: Serotonin Syndromementioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Edinoff

Akuly

Hanna

et al. 2021

Neurology International

185

View full text Add to dashboard Cite

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“…A case report study is mentioned here, which reported a possible relation of serotonin syndrome and CYP2C19 PM status. Schult et al revealed that impaired CYP2C19 activity may increase the plasma concentration and toxicity of citalopram [122]. A cross-sectional study by Castro et al, which included 9777 subjects who were treated with citalopram, revealed modest QT (QT time, ECG) prolongations with citalopram [123].…”

Section: Citalopram and Escitaloprammentioning

confidence: 99%

Pharmacogenetics and Pain Treatment with a Focus on Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Antidepressants: A Systematic Review

et al. 2022

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Background: This systematic review summarizes the impact of pharmacogenetics on the effect and safety of non-steroidal anti-inflammatory drugs (NSAIDs) and antidepressants when used for pain treatment. Methods: A systematic literature search was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines regarding the human in vivo efficacy and safety of NSAIDs and antidepressants in pain treatment that take pharmacogenetic parameters into consideration. Studies were collected from PubMed, Scopus, and Web of Science up to the cutoff date 18 October 2021. Results: Twenty-five articles out of the 6547 initially detected publications were identified. Relevant medication–gene interactions were noted for drug safety. Interactions important for pain management were detected for (1) ibuprofen/CYP2C9; (2) celecoxib/CYP2C9; (3) piroxicam/CYP2C8, CYP2C9; (4) diclofenac/CYP2C9, UGT2B7, CYP2C8, ABCC2; (5) meloxicam/CYP2C9; (6) aspirin/CYP2C9, SLCO1B1, and CHST2; (7) amitriptyline/CYP2D6 and CYP2C19; (8) imipramine/CYP2C19; (9) nortriptyline/CYP2C19, CYP2D6, ABCB1; and (10) escitalopram/HTR2C, CYP2C19, and CYP1A2. Conclusions: Overall, a lack of well powered human in vivo studies assessing the pharmacogenetics in pain patients treated with NSAIDs or antidepressants is noted. Studies indicate a higher risk for partly severe side effects for the CYP2C9 poor metabolizers and NSAIDs. Further in vivo studies are needed to consolidate the relevant polymorphisms in NSAID safety as well as in the efficacy of NSAIDs and antidepressants in pain management.

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“…Citalopram is an antidepressant drug, only available by prescription, belonging to the selective serotonin reuptake inhibitor (SSRI) class, approved for the treatment of major depression and panic disorders with or without agoraphobia with minimal effects on norepinephrine and dopamine reuptake [13]. In the case of therapeutic use, it is rarely associated with severe side effects and serotonin syndrome (SS), characterized by specific symptoms such as mental status changes, autonomic hyperactivity and neuromuscular abnormalities, occurs only in a few cases, often related to alterations in cytochrome P450 (CYP)-mediated metabolism [14]. Recreational uses of citalopram are not currently reported in the literature.…”

Section: Citaloprammentioning

confidence: 99%

Forensic Aspects of a Fatal Intoxication Involving Acetaminophen, Citalopram and Trazodone: A Case Report

Mannocchi

Tittarelli

Pantano³

et al. 2022

Toxics

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We report the case of a young man, a former heroin addict, found dead at home by the Police Forces in an advanced state of decomposition. Numerous blisters and unpacked tablets of medications were found all over the bed and on the floor of the room. Multiple injuries to the face, left arm and neck of the deceased were noted. The latter damages were attributed to post-mortem dog bites, since no indications of a possible defense against the animal were observed. The autopsy findings were unremarkable. Toxicological investigations performed on peripheral blood and urine by gas chromatography-mass spectrometry (GC-MS) technique showed the presence of acetaminophen, citalopram and trazodone. Combined drug intoxication was proposed as the cause of death since acetaminophen and trazodone concentrations were comparable with the ones found in fatal cases. Moreover, citalopram concentration in peripheral blood was above the toxic range and in accordance with levels found in fatalities due to poly-drug intoxication.

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Citalopram overdose and severe serotonin syndrome in an intermediate metabolizing patient

Cited by 9 publications

References 7 publications

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Pharmacogenetics and Pain Treatment with a Focus on Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Antidepressants: A Systematic Review

Forensic Aspects of a Fatal Intoxication Involving Acetaminophen, Citalopram and Trazodone: A Case Report

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