Citalopram Overdose-Review of Cases Treated in Swedish Hospitals

Personne, Mark; Sjöberg, Gunilla; Persson, Hans

doi:10.3109/15563659709001206

Cited by 90 publications

(58 citation statements)

References 5 publications

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“…In this context, it is noteworthy that for almost a decade now the most commonly used thymoleptic drug in Sweden, citalopram (CIT; Cipramil 1 ) (Personne et al, 1997), is administered as a racemate without su cient data available on the enantiomer-speci®c outcome of this procedure. Further, CIT is considered the most selective of the currently clinical available SSRIs, having no, or very little, a nity for NA or dopamine uptake sites, and CIT is believed not to inhibit monoamine oxidase (Hyttel et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

“…Even if the SSRIs are considered less toxic compared with the TCAs, risks of developing serious side e ects such as ECG abnormalities and convulsions have been evidenced for CIT as a consequence of larger ingested doses by patients (Grundemar et al, 1997;Personne et al, 1997). Furthermore, fatal overdoses have been reported where CIT alone was the cause of death (Worm et al, 1998;O È stroÈ m et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

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In vivo steady‐state pharmacokinetic outcome following clinical and toxic doses of racemic citalopram to rats

Kugelberg

Apelqvist

Carlsson

et al. 2001

British J Pharmacology

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1 The thymoleptic drug citalopram (CIT) belongs to the selective serotonin reuptake inhibitors (SSRIs) and is today extensively used in psychiatry. Further clari®cation of the enantiomer-selective distribution of racemic CIT in both clinical and toxic doses is highly warranted. 2 By a steady-state in vivo paradigm, rats underwent chronic systemic exposure for 10 days by using osmotic pumps and the total as well as the individual distributions of the S-and Renantiomers of CIT, and its metabolites in serum and two di erent brain regions, were analysed. 3 In serum, the S/R ratios in the groups treated with 10, 20, or 100 mg kg 71 day 71 were 0.94, 0.83, and 0.34, respectively. The ratios were almost the same in the brain regions. 4 In the group treated with 100 mg kg 71 day 71 , the serum and brain total CIT levels were found to be 20 times and 6 ± 8 times higher than in the rats treated with 10 or 20 mg kg 71 day 71 , respectively. In all groups, the CIT levels were higher in brain tissue as compared to serum. 5 In a spontaneous open-®eld behavioural test, a correlation between clinical and toxic drug concentrations was observed. 6 In conclusion, the R-enantiomer was present in an increased proportion compared with the Senantiomer when higher steady-state CIT concentration was prevailing. This is of particular interest, since the S-enantiomer is responsible for the inhibition of serotonin reuptake in vitro. The present data may be of importance, as full understanding on where di erent racemic or enantiomeric drug e ects of CIT and its main metabolites are unravelled.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vivo steady‐state pharmacokinetic outcome following clinical and toxic doses of racemic citalopram to rats

Kugelberg

Apelqvist

Carlsson

et al. 2001

British J Pharmacology

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“…In a small case series of isolated citalopram overdoses reported to a poison center, symptoms were more severe with ingestions greater than 600 mg, leading to seizures in 18 %, and in patients ingesting greater than 1900 mg, seizures were present in 47 % [9]. In citalopram overdoses under 600 mg, neurologic symptoms were generally mild and limited to dizziness, tremor, drowsiness, palpitations, tachycardia, and somnolence [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…In citalopram overdoses under 600 mg, neurologic symptoms were generally mild and limited to dizziness, tremor, drowsiness, palpitations, tachycardia, and somnolence [9,10]. It should be kept in mind that poison center data is subject to reporting bias, often secondhand, and without confirmatory drug levels and that these dose-response relationships have not been validated in a prospective study.…”

Section: Discussionmentioning

confidence: 99%

Citalopram Overdose: a Fatal Case

Kraai

Seifert

2014

J. Med. Toxicol.

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Background Citalopram is a selective serotonin reuptake inhibitor (SSRI) with cardiac and neurologic toxicities as well as the potential for serotonin syndrome. In most instances, patients recover fully from toxic ingestions of SSRIs. We describe a fatal case of a citalopram overdose. Case Report A 35-year-old woman presented to the emergency department after having witnessed seizures at home. An empty citalopram prescription bottle was located, and an intentional overdose was suspected. At the scene, she was found to be in cardiac arrest with pulseless electrical activity and underwent cardiopulmonary resuscitation, including intravenous epinephrine and bicarbonate. In the emergency department, her physical exam was notable for cough and gag reflexes and movement in all extremities with increased muscle tone and tachycardia. Her initial postresuscitation ECG showed sinus rhythm with QRS 92 ms and QTc 502 ms. Her temperature was initially normal, but she rapidly became febrile to 41.8°C shortly after admission. She was treated symptomatically and with cyproheptadine for suspected serotonin syndrome (SS) but became increasingly hemodynamically unstable over the next 6 h and then developed torsades des pointes (TdP) progressing to pulseless, wide complex tachycardia. She underwent cardiopulmonary resuscitation (CPR) for approximately 50 min but ultimately expired. Postmortem serum analysis revealed a citalopram concentration of 7300 ng/mL (therapeutic range 9-200 ng/mL) and THC, but no other nonresuscitation drugs or substances. Case Discussion Citalopram overdoses often have only mild to moderate symptoms, particularly with ingestions under 600 mg in adults. However, with higher doses, severe manifestations have been described, including QTc prolongation, TdP, and seizures. Serotonin syndrome has also been described in SSRI overdose, and our patient exhibited signs consistent with SS, including increased muscle tone and autonomic dysregulation. Our patient's serum concentration suggests a massive overdose, with major clinical effects, possible SS, and death. Conclusions Although most patients recover from citalopram overdose, high-dose ingestions can produce severe effects and fatalities may occur. In this case, it is likely that the patient's delayed presentation also contributed significantly to her death. The clinician must be aware of the potential for large ingestions of citalopram to produce life-threatening effects and monitor closely for the neurologic, cardiovascular, and other manifestations that, in rare cases, can be fatal.

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“…Trials prospettici ed analisi retrospettive hanno confermato la safety del citalopram sul piano cardiovascolare, rilevando come unico effetto ECGrafico una modesta riduzione della frequenza cardiaca (8 battiti/minuto), in assenza di modifiche significative sugli intervalli PQ, QRS o QT, sulla conduzione e sulla ripolarizzazione cardiaca, nei trattamento sia a breve che a lungo termine (Rasmussen Epidemiologia e Psichiatria Sociale, 11, 2, 2002. Vanno segnalate le rare osservazioni di cardiotossicita, in casi di sovradosaggio (tra 600 mg e 2 g) a scopo suicidario, correlate all'idrossimetabolita del citalopram, non significativamente attivo nei range posologici abituali (Personne et al, 1997).…”

Section: Trattamento Della Depressione E Del-l'ansia In Corso DI Malaunclassified

Depression, anxiety and cardiovascular disease: biological correlations and therapeutic strategies

Torta

Scalabrino

2002

Epidemiol Psichiatr Soc

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Citalopram Overdose-Review of Cases Treated in Swedish Hospitals

Abstract: The findings are consistent with previous reports claiming that selective serotonin reuptake inhibitors are less toxic compared to tricyclic antidepressants. However, there is a risk of developing serious symptoms when large doses have been ingested.

Cited by 90 publications

References 5 publications

In vivo steady‐state pharmacokinetic outcome following clinical and toxic doses of racemic citalopram to rats

In vivo steady‐state pharmacokinetic outcome following clinical and toxic doses of racemic citalopram to rats

Citalopram Overdose: a Fatal Case

Depression, anxiety and cardiovascular disease: biological correlations and therapeutic strategies

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