Fluoxetine/venlafaxine overdose
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Cardiogenic shock and serotonin syndrome: case report A 27-year-old woman developed cardiogenic shock and serotonin syndrome following an overdose of fluoxetine [Prozac] and venlafaxine [Effexor LP]. The woman presented with status convulsions associated with serotonin syndrome, following selfpoisoning with fluoxetine 1280mg and venlafaxine 4500mg [routes and time to reaction onset not stated]. Tests revealed a venlafaxine concentration of 5.0 mg/L (toxic concentration 0.4 mg/L) and a fluoxetine concentration of 1.6 mg/L (toxic concentration 0.3 mg/L). The woman received sodium valproic acid and clonazepam, and her convulsions resolved. That night, a transthoracic echocardiogram revealed left heart failure, global hypokinesia, apical akinesia and a left ventricular ejection fraction (LVEF) of 20%. Further tests revealed decreased cardiac output, a brain natriuretic peptide level of 2180 ng/L, and a troponin level of 1.01 µg/L. She was treated with dobutamine, and her condition improved. However, 2 days later, she developed hypertensive pulmonary oedema, and her venlafaxine concentration remained elevated at 1.8 mg/L. She then received furosemide, isosorbide dinitrate and ventilation. Subsequently, her clinical course was favourable, and an ultrasound revealed a normal LVEF 10 days after poisoning. Malfroy S, et al. Cardiogenic shock after venlafaxine poisoning. Annales Francaises d’Anesthesie et de Reanimation 30: 857-858, No. 11, Nov 2011. Available from: URL: http://dx.doi.org/10.1016/j.annfar.2011.07.007 [French; 803066508 summarised from a translation] - France
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Reactions 4 Feb 2012 No. 1387
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