Abstract | BACKGROUND: OBJECTIVE: To determine the effect of SSRIs in overdose, as a group, and the relative toxicity of five different SSRIs. METHODS: RESULTS: There were 469 SSRI poisoning admissions analyzed after exclusions. The median LOS for all SSRI overdose admissions was 15.3 h (IQR: 10.5-21.3) and 30 of 469 (6.4%; 95% CI 4.3-9.0%) cases were admitted to ICU. The incidence of seizures was 1.9% and coma was 2.4%. Serotonin syndrome occurred in 14% of overdoses. Comparison of median QTc intervals of the five SSRIs was significantly different (p=0.0002); citalopram (450 IQR: 436-484) was individually different to fluoxetine (p=0.045), fluvoxamine (p=0.022), paroxetine (p=0.0002), and sertraline (p=0.001). The proportion of citalopram overdoses with a QTc >440 msec was 68%, differing significantly from sertraline (adjusted OR: 5.11 95% CI 2.32-11.27). Comparison of median QT intervals of the five SSRIs was statistically different (p=0.026); citalopram (400 IQR: 380-440) was individually different from sertraline (p=0.023). CONCLUSIONS: This study shows SSRIs are relatively safe in overdose despite serotonin syndrome being common. The exception was citalopram, which was significantly associated with QTc prolongation. We believe that cardiac monitoring should be considered in citalopram overdose, particularly with large ingestions and patients with associated cardiac disease.
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Authors | Geoffrey K Isbister, Steven J Bowe, Andrew Dawson, Ian M Whyte |
Journal | Journal of toxicology. Clinical toxicology
(J Toxicol Clin Toxicol)
Vol. 42
Issue 3
Pg. 277-85
( 2004)
ISSN: 0731-3810 [Print] United States |
PMID | 15362595
(Publication Type: Journal Article)
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Chemical References |
- Serotonin Uptake Inhibitors
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Topics |
- Adolescent
- Adult
- Age Factors
- Aged
- Arrhythmias, Cardiac
(chemically induced)
- Australia
(epidemiology)
- Cardiovascular Diseases
(chemically induced, physiopathology)
- Cohort Studies
- Coma
(chemically induced, therapy)
- Critical Care
- Drug Overdose
- Electrocardiography
(drug effects)
- Female
- Heart Diseases
(chemically induced, physiopathology, therapy)
- Humans
- Length of Stay
- Logistic Models
- Male
- Middle Aged
- Neurotoxicity Syndromes
(physiopathology, therapy)
- Poison Control Centers
- Seizures
(chemically induced, therapy)
- Serotonin Syndrome
(physiopathology, therapy)
- Selective Serotonin Reuptake Inhibitors
(poisoning, toxicity)
- Sex Factors
- Treatment Outcome
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