Fatal cardiotoxicity induced by venlafaxine overdosage

Höjer, Jonas; Hulting, Johan; Salmonson, Heléne

doi:10.1080/15563650701358755

Cited by 33 publications

(26 citation statements)

References 5 publications

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“…There are reports in the literature of myocardial infarction [23], tachycardia [24], worsening heart failure [25] and cardiovascular-related death [26], whilst receiving venlafaxine or duloxetine, and particular warnings have been appended to product information. It may be appropriate to re-examine the nature of the cardiac event profile associated with these agents in order to facilitate both appropriate diagnosis and treatment in the future.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

Neil

Chong

Nguyen

et al. 2012

Heart, Lung and Circulation

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Section: Discussionmentioning

confidence: 99%

Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

Neil

Chong

Nguyen

et al. 2012

Heart, Lung and Circulation

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“…Many of the newer antidepressants have been shown to be safer in overdose compared with the older tricyclic antidepressants. However, venlafaxine appears to be more toxic than other newer antidepressants, with a higher rate of fatalities [1], increased risk of seizures [2] and cardiac toxicity reported with massive ingestions [3]. Serotonin toxicity and seizures are the most important clinical effects commonly reported following venlafaxine overdoses and occur across a range of doses.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiogram changes and arrhythmias in venlafaxine overdose

Isbister

2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The major clinical effects of venlafaxine overdose are seizures and serotonin toxicity. • There is controversy over the risk of cardiac toxicity in venlafaxine overdose. WHAT THIS STUDY ADDS• Venlafaxine overdose is unlikely to cause clinically significant cardiac toxicity, including QT prolongation or malignant arrhythmias, and the commonest cardiovascular effects are tachycardia and mild hypertension.• Massive ingestions >8 g may result in cardiac toxicity and patients should be observed carefully. AIMSTo investigate serial electrocardiogram (ECG) parameters, haemodynamic changes and arrhythmias following venlafaxine overdose. METHODSThe study included 369 venlafaxine overdoses in 273 patients presenting to a toxicology unit where an ECG was available. Demographic information, details of ingestion, haemodynamic effects [heart rate and blood pressure (BP)] and complications (arrhythmias and conduction defects) were obtained. ECG parameters (QT, QRS) were measured manually and analysed by visual inspection, including plotting QT-HR pairs on a QT nomogram. RESULTSThe median ingested dose was 1500 mg [interquartile range (IQR) 600-3000 mg; range 75-13 500 mg). Tachycardia occurred in 54% and mild hypertension (systolic BP >140 mmHg) in 40%. Severe hypertension (systolic BP >180 mmHg) and hypotension (systolic BP <90 mmHg) occurred in 3% and 5%, respectively. No arrhythmias occurred based on continuous telemetry, and conduction defects were found in only seven of 369 admissions; five of these conduction defects were pre-existing abnormalities. In 22 admissions [6%, 95% confidence interval (CI) 4-10] there was an abnormal QT-HR pair, with larger doses being more likely to be associated with an abnormal QT. The median maximum QRS width was 85 ms (IQR 80-90 ms; range 70-145 ms) and the QRS was greater than 120 ms in only 24 admissions (7%, 95% CI 4-10). CONCLUSIONSVenlafaxine overdose causes only minor abnormalities in the QT and QRS intervals, unlikely to be associated with major arrhythmias, except possibly with large doses.

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“…Also, unlike the reports of adult overdoses in the literatures, none of the 262 pediatric cases called in resulted in fatality. The maximum pediatric venlafaxine dose in this study was 9 g, and the doses resulting in fatalities in adults were above 10 g. 16,21 In contrast to many of the adult reports that include plasma concentrations along with dose or dose per weight, peak plasma levels were not available for the children in this study through the CPCS. 21,27 Although this study aimed to provide a more thorough description of cases of venlafaxine ingestion in pediatrics, it is not without limitations.…”

Section: Discussionmentioning

confidence: 94%

“…The maximum pediatric venlafaxine dose in this study was 9 g, and the doses resulting in fatalities in adults were above 10 g. 16,21 In contrast to many of the adult reports that include plasma concentrations along with dose or dose per weight, peak plasma levels were not available for the children in this study through the CPCS. 21,27 Although this study aimed to provide a more thorough description of cases of venlafaxine ingestion in pediatrics, it is not without limitations. As stated previously, around one-third of the cases of venlafaxine ingestion in pediatrics that was reported to the CPCS between 2001 and 2011 did not meet criteria for the study for various reasons (Figure 1).…”

Section: Discussionmentioning

confidence: 94%

An 11-year retrospective review of venlafaxine ingestion in children from the California Poison Control System

et al. 2015

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Venlafaxine is commonly used in the United States for approved and non-Food and Drug Administration–approved indications in adults. It is used off-label to treat children for psychiatric diagnoses. The aim of the study was to describe venlafaxine toxicities in children and to identify the venlafaxine dose per weight that correlates with toxicities. An 11-year retrospective study of venlafaxine ingestion in children was performed using the California Poison Control System (CPCS) database. Data was extracted from phone calls received by CPCS clinicians and follow-up phone calls made to assess the patient’s progress in a health-care setting. Inclusion criteria were venlafaxine ingestion cases reported to CPCS between January 2001 and December 2011, children aged 20 years and under, venlafaxine as the only ingested substance, managed in a health-care facility, and followed to a known outcome. Two hundred sixty-two cases met the study criteria. Common presentations included gastrointestinal (14.9%), altered mental status (13.7%), and tachycardia (13.4%). The majority of the cases resulted in no effect (51.5%) or minor effect (19.9%). The average estimated dose per weight was 18.3 mg/kg in all patients and 64.5 mg/kg in those experiencing moderate-to-severe adverse effects. Seizures occurred in only 4 of the 262 cases at doses ranging from 1500 to 7500 mg. Although the estimated dose per weight exceeded 10 mg/kg for the majority of the cases, only 12 cases resulted in moderate or severe outcomes. The majority of venlafaxine ingestion cases in children resulted in either no clinical effects or minor clinical effects.

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Fatal cardiotoxicity induced by venlafaxine overdosage

Cited by 33 publications

References 5 publications

Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

Electrocardiogram changes and arrhythmias in venlafaxine overdose

An 11-year retrospective review of venlafaxine ingestion in children from the California Poison Control System

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