Mirtazapine overdose with benign outcome

Raja, Michele; Azzoni, Antonella

doi:10.1016/s0924-9338(02)00636-3

Cited by 11 publications

(4 citation statements)

References 5 publications

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“…Although there have been studies on mirtazapine overdose, they did not establish any association between mirtazapine intoxication and neutropenia onset 9–13 . To the best of our knowledge, the present case is the first report of neutropenia in a patient intoxicated because of excessive mirtazapine intake.…”

Section: Discussioncontrasting

confidence: 58%

Mild Neutropenia After Suicide Attempt With 900 Milligrams Intake of Mirtazapine

Mutlu

Kavla

Demirel

2021

J Clin Psychopharmacol

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Section: Discussioncontrasting

confidence: 58%

Mild Neutropenia After Suicide Attempt With 900 Milligrams Intake of Mirtazapine

Mutlu

Kavla

Demirel

2021

J Clin Psychopharmacol

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“…A recent case report of a patient who ingested 30 times the normal daily dose of mirtazapine in a suicide attempt reported no adverse sequelae. 3 Bupropion has associated toxicities, such as central nervous system effects (seizures), but rarely, cardiotoxicities, 4,5 whereas nefazodone demonstrated a low toxicity profile in overdose situations in an analysis of 1338 exposures. 6 However, venlafaxine overdose has been associated with excess adrenergic stimulation, seizures, 2, 7 arrhythmias, 8 bradycardia, hypertension, hypotension, 9 and death.…”

mentioning

confidence: 99%

Fatality Related to a 30‐g Venlafaxine Overdose

2003

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A 30-g venlafaxine overdose resulted in death for a 39-year-old woman whose 43-day clinical course was highlighted by refractory hypotension and the resulting complications of bowel ischemia and perforation. Her venlafaxine and O-desmethylvenlafaxine levels, analyzed by high-performance liquid chromatography one day after ingestion, were 21.82 mg/L (therapeutic range 0.1-0.5 mg/L) and 3.33 mg/L (0.2-0.4 mg/L), respectively. These levels remained elevated for over 7 days. Postulated explanations for these extended elevated levels were saturation of drug metabolism, decreased drug metabolism, and existence of a genetic polymorphism. Our patient's venlafaxine overdose produced a wide variety of clinical challenges, to include seizures, tachycardia, decreased level of consciousness, refractory hypotension, and bowel dysmotility. In addition, this case augments the growing body of literature that suggests that venlafaxine may be fatal in overdose situations.

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“…There is not a single case report of typical ST with MIRT alone, in either overdose or therapeutic dose. There are eight separate reports in the literature containing a total of 14 patients with MIRT-alone overdoses, none of whom exhibited any signs of serotonergic toxicity (Bremner et al, 1998;Garlipp et al, 2003;Gerritsen, 1997;Hoes and Zeijpveld, 1996a;Holzbach et al, 1998;Raja and Azzoni, 2002;Retz et al, 1998;Velazquez et al, 2001). There are four reports of ST with MIRT in combination with other SRIs that are known to cause ST by themselves (Benazzi, 1998;Demers and Malone, 2001), 2 of which are with venlafaxine (Dimellis, 2002;Houlihan, 2004), which is a particularly potent precipitator of ST by itself.…”

Section: Individual Case Reports Concerning Mirtazapinementioning

confidence: 99%

A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status

Gillman¹

2006

Hum. Psychopharmacol. Clin. Exp.

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A systematic review of published work concerning mirtazapine was undertaken to assess possible evidence of serotonergic effects or serotonin toxicity (ST) in humans, because drug toxicity and interaction data from human over-doses is an useful source of information about the nature and potency of drug effects. There is a paucity of evidence for mirtazapine having effects on any indicator of serotonin elevation, which leads to an emphasis on ST as an important line of evidence. Mirtazapine is compared with its analogue mianserin, and other serotonergic drugs. Although mirtazapine is referred to as a dual-action 'noradrenergic and specific serotonergic drug' (NaSSA) little evidence to support that idea exists, except from initial microdialysis studies in animals showing small effects; those have not subsequently been replicated or substantiated by independent researchers. Also, new data indicate its affinity for Alpha 2 adrenoceptors is not different to mianserin. It appears to exhibit no serotonergic symptoms or toxicity in over-dose by itself, nor is there evidence that it precipitates ST in combination with monoamine oxidase inhibitors, as would be expected if it raises intra-synaptic serotonin levels. Mirtazapine has no demonstrable serotonergic effects in humans and there is insufficient evidence to designate it as a dual-action drug.

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Mirtazapine overdose with benign outcome

Cited by 11 publications

References 5 publications

Mild Neutropenia After Suicide Attempt With 900 Milligrams Intake of Mirtazapine

Mild Neutropenia After Suicide Attempt With 900 Milligrams Intake of Mirtazapine

Fatality Related to a 30‐g Venlafaxine Overdose

A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status

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