Status epilepticus following intentional overdose of fluvoxamine: A case report with serum fluvoxamine concentration

Abstract

Introduction. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) that is used in the management of depression and obsessive compulsive disorders. We report a patient with status epilepticus requiring quadruple anti-convulsant treatment following a fluvoxamine overdose. Case Report. A 25-year-old female presented with drowsiness at 12 hours following deliberate ingestion of 9.6 grams of fluvoxamine. Sixteen hours after ingestion, she developed status epilepticus that required treatment with benzodiazepines (lorazepam and midazolam), thiopentone, phenytoin and phenobarbitone. Her serum fluvoxamine concentration on presentation was 1970 μg/L (therapeutic 160-220 μg/L) and routine toxicological screening was negative for other drugs. She was discharged home after 72 hours with no further episodes of seizures. Discussion. Most patients with fluvoxamine poisoning are either asymptomatic or may develop mild signs of serotonergic toxicity. Although serotonin syndrome and isolated seizures are reported in fluvoxamine poisoning, we report the first patient with confirmed isolated fluvoxamine toxicity who developed status epilepticus.

Refractory status epilepticus, circulatory collapse after cardiac arrest, and acute respiratory distress syndrome caused by severe isolated fluvoxamine poisoning: a case report

“…On the other hand, fluvoxamine overdoses over 9 g often produce severe symptoms (Table ). A 25‐year‐old female ingested 9.6 g isolated fluvoxamine and developed status epilepticus, which was successfully treated with benzodiazepines (lorazepam and midazolam), thiopentone, phenytoin, and phenobarbitone . A 40‐year‐old male ingested 10 g fluvoxamine and developed status epilepticus, refractory hypotension, and necrotizing pneumonia believed to be secondary to aspiration; his multiple self‐limited seizures were successfully treated with several doses of lorazepam, phenytoin, and empiric pyridoxine.…”

Treatment of drug‐induced seizures

“…Phenobarbital is as effective as lorazepam for patients with status epilepticus, although it requires a longer infusion time . Barbiturates have been reported effective in treating citutoxin and fluvoxamine‐induced seizures which were not responsive to benzodiazepines and phenytoin . Experimental evidence supports that phenobarbital is superior to phenytoin in prevention of theophylline‐induced seizure and death .…”

A Rare Overlap of Serotonin Syndrome and Status Epilepticus Confirmed on Electroencephalogram

“…This occurs most commonly due to interactions between selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors [2,3]. Fluoxetine is an SSRI that increases the post-synaptic activity of serotonin and can be used for depression [5]. Munhoz reported a case of SS caused by bupropion [4].…”