Symptoms and signs of severe citalopram overdose

Grundemar, Lars; Wohlfart, Björn; Lagerstedt, C; Bengtsson, Finn; Eklundh, Göran

doi:10.1016/s0140-6736(05)61630-3

Cited by 84 publications

(42 citation statements)

References 5 publications

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“…However, there were several level 4 or 6 articles that included patients 6 years of age and older with acute citalopram ingestion and from which some dose-toxicity information could be extracted (8,9,11,26,27,42,43). Unfortunately, most of these articles reported the ages and doses as ranges or using summary data, making it impossible to associate clinical effects with dose and age.…”

Section: Citaloprammentioning

confidence: 99%

“…Seizures and cardiac electrophysiologic abnormalities (generally QTc interval prolongation) can occur and are most widely reported following overdoses with citalopram (8)(9)(10)(11). Consequential clinical effects can result uncommonly from any agent of this class due to the development of the serotonin syndrome, which manifests as autonomic instability, altered mental status, seizures, extrapyramidal syndrome including muscle rigidity, hyperthermia, and, rarely, death.…”

Section: Introductionmentioning

confidence: 99%

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Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management

Nelson

Erdman

Booze

et al. 2007

Clinical Toxicology

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments.The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of an SSRI by 1) describing the process by which an ingestion of an SSRI might be managed, 2) identifying the key decision elements in managing cases of SSRI ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of immediate-release forms of SSRIs alone. Co-ingestion of additional substances might require different referral and management recommendations depending on their combined toxicities.This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment.Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department. This activity should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D). 2) Any patient already experiencing any symptoms other than mild effects (mild effects include vomiting, somnolence [lightly sedated and arousable with speaking voice or light touch], mydriasis, or diaphoresis) should be transported to an emergency department. Transportation via ambulance should be considered based on the condition of the patient and the length of time it will take the patient to arrive at the emergency department (Grade D). 3) Asymptomatic patients or those with mild effects (defined above) following isolated unintentional acute SSRI ingestions of up to five times an initial adult therapeutic dose (i.e., citalopram 100 mg, escitalopram 50 mg, fluox...

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Section: Citaloprammentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management

Nelson

Erdman

Booze

et al. 2007

Clinical Toxicology

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“…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%

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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“…Seizures, prolonged QT intervals and sinus tachycardia have been described in a study with five patients who took up to 5200 mg of citalopram. 4 A review of 44 patients with citalopram overdose ≥ 600 mg showed seizures and ECG changes. 5 In this study the frequency of patients developing seizures was 14%, an almost identical result to our investigation.…”

Section: Statistical Evaluationmentioning

confidence: 99%

“…Seizures, ECG changes such as prolonged QT intervals and sinus tachycardia have been described in studies with citalopram overdose. 4,5,6 In contrast, a study with 28 cases involving accidental or intentional overdose of escitalopram found that no patient developed adverse sequelae. 7 In another study the most frequent symptoms were neurological (drowsiness, dizziness, agitation and tremor), followed by gastrointestinal (vomiting and nausea) and cardiovascular (tachycardia).…”

mentioning

confidence: 96%

Escitalopram causes fewer seizures in human overdose than citalopram

Yilmaz¹,

Ceschi²,

Rauber-Lüthy³

et al. 2010

Clinical Toxicology

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CONTEXT: Seizures are a recognized complication of acute overdose with the racemic (1:1 ratio of R-and S-enantiomers) selective serotonin reuptake inhibitor antidepressant citalopram. OBJEC-TIVE: We tested the hypothesis that escitalopram (the therapeutically active S-enantiomer of citalopram) causes fewer seizures in overdose than citalopram at comparable doses of the S-enantiomer. METHODS: Multicenter retrospective review of cases with citalopram and escitalopram overdose reported to German, Austrian, and Swiss Poisons Centers between 1997 and 2006. RESULTS: 316 citalopram and 63 escitalopram cases were analyzed. Somnolence, nausea, vomiting, tachycardia, QT prolongation, and tremor occurred with similar frequency in both groups. There was a striking difference in the frequency of single and multiple seizures: 43 cases (13.5%) in the citalopram group and 1 case (1.6%) with a single seizure in the escitalopram group (p=0.0065). DISCUSSION AND CONCLUSIONS: At comparable ingested doses of the S-enantiomer, the symptom profile for citalopram and escitalopram intoxications is similar except for seizures that occur more frequently in citalopram than in escitalopram poisoning.

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Symptoms and signs of severe citalopram overdose

Cited by 84 publications

References 5 publications

Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management

Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management

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

Escitalopram causes fewer seizures in human overdose than citalopram

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