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Pulmonary embolism (first report with nortriptyline) and death: case report A woman died after experiencing bilateral pulmonary emboli during treatment with nortriptyline and risperidone for psychosis not otherwise specified [routes and durations of treatment to reaction onset not stated]. The woman was diagnosed at 19 years of age and began receiving risperidone 5mg and olanzapine. Venlafaxine and nortriptyline 100mg [frequency not stated] were added after symptoms of major depression were discovered. She developed hyperprolactinaemia with amenorrhoea and weight gain; risperidone was discontinued. After 13 months of euthymia she had re-emergence of her symptoms, having discontinued her medication due to the weight gain. Risperidone was reinitiated at 1mg twice daily and she was readmitted. Olanzapine was discontinued and her risperidone dosage was increased to 1mg in the morning and 2mg at night. The following morning, she was found unconscious on the floor, with low blood pressure and superficial breathing. On arrival of a medical team, she was pulseless, no longer breathing and had fixed mydriasis. Resuscitation was attempted, but she was pronounced dead one hour later. She had received loxapine 25mg and diphenhydramine 25mg most recently, and risperidone 2mg and nortriptyline 100mg the previous night. The coroner concluded that she had experienced massive bilateral pulmonary emboli linked to nortriptyline and risperidone. Rousseau A-M. Hyperprolactinemia and atypical antipsychotic therapy in a case of fatal thromboembolism. Journal of Clinical Psychopharmacology 30: e734-735, No. 6, Dec 2010. Available from: URL: http://dx.doi.org/10.1097/ 803047842 jcp.0b013e3181fbbb69 - Canada

» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of pulmonary embolism associated with nortriptyline. The WHO ADR database contained 3 reports of pulmonary embolism associated with nortriptyline.

0114-9954/10/1334-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Reactions 15 Jan 2011 No. 1334