A depressed myocardium.
BACKGROUND
Venlafaxine is a potent neuronal serotonin and noradrenaline re-uptake inhibitor, and to a lesser extent an inhibitor of dopamine reuptake. Paroxetine is a potent selective inhibitor of serotonin reuptake.


METHODS
A 27-year-old man ingested 1987.5 mg of venlafaxine and 360 mg of paroxetine. He subsequently developed systolic and diastolic hypertension, transient electrocardiographic abnormalities, and an area of persistent myocardial damage. He recovered from his overdose with his blood pressure and electrocardiogram returning to normal. The area of myocardial damage was documented on echocardiogram as an area of marked hypokinesia at the basal anterior septum. Despite the absence of confirming blood levels or the absolute exclusion of cocaine, this case indicates that venlafaxine and paroxetine have the potential for serious cardiotoxicity when taken in overdose.
Taunton and Somerset NHS Trust, England, United Kingdom. samuel@langford134.freeserve.co.uk
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Partridge
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MacIver
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Solanki
D000328:Adult; D000889:Anti-Arrhythmia Agents; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis*; D002637:Chest Pain / Q000139:chemically induced; D003511:Cyclohexanols / Q000506:poisoning*; D004562:Electrocardiography; D006321:Heart / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced; D008297:Male; D017374:Paroxetine / Q000506:poisoning*; D017367:Selective Serotonin Reuptake Inhibitors / Q000506:poisoning*; D013616:Tachycardia, Sinus / Q000139:chemically induced; D000069470:Venlafaxine Hydrochloride; D016277:Ventricular Function, Left / Q000187:drug effects
D000889:Anti-Arrhythmia Agents; D003511:Cyclohexanols; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride