Relative safety of mirtazapine overdose.
A 43-y-o male with a history of AIDS, atrial fibrillation, and alcohol abuse presented to the emergency department 2 h after ingestion of 25 tablets of 15 mg mirtazapine (total 375 mg) with ethanol in a suicide attempt (no other coingestion). Vital signs were normal except for a mild tachycardia (rate 112). Physical examination was unremarkable except for lethargy. Fifty grams of activated charcoal with sorbitol was given. Electrocardiogram showed sinus tachycardia, left ventricular hypertrophy, and non-specific ST-segment changes. Serum mirtazapine on admission was 530 ng/mL (therapeutic level 20-50 ng/mL). Overnight monitoring revealed no tachyarrythmias, and discharge occurred after psychiatric evaluation. It appears that ingestions of mirtazapine approximately 10-fold of therapeutic exhibit minimal acute toxicity. From this and other cases in the literature exhibiting a 10-fold overdose, we conclude that isolated mirtazapine ingestions of this magnitude require no acute intervention other than short term (about 6 h) observation.
Velazquez
C
C
Washington University, St Louis, MO 63110, USA.
Carlson
A
A
Stokes
K A
KA
Leikin
J B
JB
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D002400:Cathartics / Q000627:therapeutic use*; D002606:Charcoal / Q000627:therapeutic use*; D062787:Drug Overdose; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000506:poisoning*; D000078785:Mirtazapine; D013012:Sorbitol / Q000627:therapeutic use*; D013406:Suicide, Attempted; D013610:Tachycardia / Q000139:chemically induced; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D002400:Cathartics; D002606:Charcoal; D008803:Mianserin; D013012:Sorbitol; D000078785:Mirtazapine