Tricyclic Antidepressant Overdose Treated with Adjunctive Lipid Rescue and Plasmapheresis

Odigwe, Chibuzo; Tariq, Madiha; Kotecha, Tulsi; Mustafa, Usman; Senussi, Nizar H.; Ikwu, Isaac; Bhattarcharya, Anirban; Ngene, John Ifeanyi; Ojiako, Kizito; Iroegbu, Nkemakolam

doi:10.1080/08998280.2016.11929437

Cited by 11 publications

(4 citation statements)

References 16 publications

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“…Multiple case reports indicate the use of intravenous lipid emulsion therapy for large-volume TCA overdose [ 10 , 11 ]. It is believed that lipid emulsion therapy creates a lipid sink to bind TCAs.…”

Section: Discussionmentioning

confidence: 99%

Tricyclic Antidepressant and Antipsychotic Toxicity: Clomipramine and Ziprasidone Overdose

Foresteire,

Howard,

Szustkiewicz

2024

Cureus

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This case report details an intentional overdose attempt utilizing tricyclic antidepressants (TCAs) and atypical antipsychotics with significant neurologic, pulmonary, and cardiac toxicity. In conjunction with the local poison control center, progression of the clinical toxidrome was anticipated, aggressively managed, and successfully treated. This case highlights the dangers of significant TCA toxicity, peak onset of toxicity within six hours, and the amplification of clinical toxidromes with co-ingestions.

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Section: Discussionmentioning

confidence: 99%

Tricyclic Antidepressant and Antipsychotic Toxicity: Clomipramine and Ziprasidone Overdose

Foresteire,

Howard,

Szustkiewicz

2024

Cureus

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“…Another case report described a patient who underwent a similar 2-step process [ 11 ]. One difference was that he received 2 plasmapheresis procedures with one per day on 2 consecutive days.…”

Section: Discussionmentioning

confidence: 99%

Use of Iatrogenic Lipid Emulsion and Subsequent Plasmapheresis for the Treatment of Amitriptyline Overdose

Laffin

Cunningham

Fitzgerald

et al. 2022

Case Reports in Critical Care

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Plasmapheresis for the treatment of hypertriglyceridemia is relatively uncommon and mostly reported either in patients experiencing hypertriglyceridemia-induced acute pancreatitis or patients with therapy-resistant familial hypercholesterolemia. Standard therapies for hypertriglyceridemia include dietary modification and lipid-lowering medication. For severe hypertriglyceridemia, the risk of pancreatitis increases significantly as triglyceride levels increase above 1000 mg/dL, and current therapies are unable to reduce triglyceride levels rapidly enough. Here, we report a case of a 48-year-old male patient who presented to the emergency department due to an amitriptyline overdose. In addition to being started on IV sodium bicarbonate therapy, an intravenous 20% fat emulsion bolus at 1.5 mL/kg was administered followed by 0.25 mL/kg/min infusion for 4 hours as a strategy to absorb lipophilic amitriptyline. Two days posttreatment, he was noted to have substantial hypertriglyceridemia (serum triglycerides: 6,475 mg/dL). His amylase was within the normal range at 37 U/L (reference range: 20-100 U/L), his lipase was low at 40 U/L (reference range: 75-390 U/L), and he was without evidence of any clinical sequelae secondary to hypertriglyceridemia (e.g., pancreatitis). Due to the severity of his hypertriglyceridemia, plasmapheresis was initiated urgently for rapid reduction in serum triglyceride levels to prevent pancreatitis and end-organ damage. He underwent a 1-plasma volume exchange with 5% albumin as the replacement fluid. This reduced his triglyceride levels to 185 mg/dL (reference range: 3-149 mg/dL). His symptoms secondary to his amitriptyline overdose were also resolved. Here, we report a 2-step process of intravenous lipid emulsion followed by plasmapheresis for amitriptyline overdose.

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“…It is possible that IL prevents tissue accumulation, which in turn would decrease adverse events. Ultimately, if increased amiodarone remains in the blood after IL administration, a subsequent directed removal (e.g., plasmapheresis) could eventually prove beneficial (tricyclic antidepressant overdose) [ 26 ]. Previously, it has been shown that the accumulation of amiodarone could trigger adverse effects in organs and tissues because of trafficking through late endosomes and induce a Niemann–Pick C-like phenotype [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic Disposition of Amiodarone When Given with an Intralipid Rescue Strategy

et al. 2021

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While the antiarrhythmic drug amiodarone is commonly used in clinical practice, it has a narrow therapeutic index that can lead to acute overdose. One proposed method to deal with this toxicity is lipid emulsion therapy, which may potentially quench the free amiodarone in blood and prevent its further distribution to target organs and tissues. In this study, we utilize an established swine model to examine the effects of Intralipid™ (IL) administration for acute amiodarone toxicity. A total of 14 pigs received an overdose of intravenous amiodarone. After twenty minutes, half of the pigs (n = 7) received IL while the control group (n = 7) received normal saline. Serum concentrations of amiodarone were then analyzed using a validated high-performance liquid chromatography (HPLC) method. Noncompartmental pharmacokinetic analyses were performed on the observed concentrations. There were no statistical differences in the area under the concentration time curve (6 h) or clearance, but there was a difference in the half-life between the two groups (3.12 vs. 0.85 h, p = 0.01). The administration of IL did not statistically change the overall exposure of amiodarone in the blood in the first 6 h; however, trends toward prolonged blood retention in the IL group were seen.

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Tricyclic Antidepressant Overdose Treated with Adjunctive Lipid Rescue and Plasmapheresis

Cited by 11 publications

References 16 publications

Tricyclic Antidepressant and Antipsychotic Toxicity: Clomipramine and Ziprasidone Overdose

Tricyclic Antidepressant and Antipsychotic Toxicity: Clomipramine and Ziprasidone Overdose

Use of Iatrogenic Lipid Emulsion and Subsequent Plasmapheresis for the Treatment of Amitriptyline Overdose

Pharmacokinetic Disposition of Amiodarone When Given with an Intralipid Rescue Strategy

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