Intoxikation mit einem trizyklischen Antidepressivum

Abstract

A 48-year-old woman with a major depression and treatment with doxepin was found comatose in her flat. Her son last saw her 48 h prior to being found. On arrival of the emergency physician, she presented a generalized seizure. The patient underwent endotracheal intubation and mechanical ventilation due to respiratory insufficiency and severe cyanosis. Empty packages of tablets (doxepin ca. 4000 mg and zolpidem 100 mg) were found in the flat. On hospital admission the doxepin blood concentration was 1.2 microg/ml. No life-threatening arrhythmia occurred at any time. On the advice of the poison information center, hemoperfusion was performed for extracorporeal elimination. Within several hours the doxepin blood concentration could be lowered to 0.8 microg/ml and although still above the therapeutic range the patient was extubated. However, the patient developed a generalized seizure which required re-intubation. As a consequence of the high distribution volume and re-distribution phenomena, the doxepin blood concentration had increased again to 1.2 microg/ml. Approximately 72 h later she was extubated again while the doxepin blood concentration was 0.9 microg/ml and 3 days later, the doxepin blood concentration was lowered to 0.3 microg/ml and the patient was transferred to the psychiatric ward the following day. This case report questions the efficacy of hemoperfusion during acute doxepin intoxication in the given constellation of a non-life-threatening arrhythmia.

Swiss Prison Suicides Between 2000 and 2010

“…Our results showed that tricyclic antidepressants are high-risk medicines for prisoners choosing to take an overdose. Overdosing on tricyclic antidepressants is generally quite common among patients being treated with these medications (Dianat et al, 2010; Sakka, Kuethe, & Hüttemann, 2007; Sinyor, Howlett, Cheung, & Schaffer, 2012). Regarding overdoses in prisoners, only a few other studies report individual cases of suicide by intoxication (Joukamaa, 1997; White et al, 2002; Wobeser et al, 2002).…”

Extracorporeal Treatment for Tricyclic Antidepressant Poisoning: Recommendations from the EXTRIP Workgroup

“…Furthermore, the application of ECTRs, even if they are usually considered generally safe, is not without cost and risks. In the present literature review, adverse effects of ECTRs, other than death, were reported: in subjects undergoing hemoperfusion, thrombocytopenia was reported in 25 patients, anemia in 12, bleeding or coagulation problems in 2, a clotting cartridge in 1, hypotension in 2, hypocalcemia in 5, and pulmonary edema in 1 . Peritoneal dialysis‐related peritonitis was reported in one patient, hyperglycemia in three cases, and hypothermia in one .…”

“…From the initial 1312 studies obtained, 77 studies met the inclusion criteria, including 1 observational study , 5 animal studies , 4 in vitro studies , 4 pharmacokinetic (PK) studies , and 63 case reports , 39 of which had sufficient toxicokinetic (TK) data. In total, 108 patients were included for analysis.…”

Koma und QT-Zeitverlängerung nach Intoxikation mit Antidepressiva

“…Liegt der Ingestionszeitpunkt nur sehr kurz zurück, kann in Ausnahmefäl-len eine Giftelimination mittels Magenspülung erwogen werden. Sekundäre Gifteliminationsverfahren werden in ihrer Effektivität kontrovers beurteilt [8,9]. Eine Hämoperfusion kann in Betracht gezogen werden (Übersicht unter [9]).…”