title: Citalopram in fatal poisoning cases.
abstract: Citalopram, a selective serotonin reuptake inhibitor, is the most frequently prescribed antidepressant in Sweden. To investigate the extent to which citalopram in overdose is found in fatal poisoning cases compared with other drugs, all fatal poisonings in one forensic medicine district in Sweden during the years 1994-1999 were examined. Drugs found in overdose in more than 10 cases were included. The ratio between number of cases with each included drug and prescription of defined daily dose/1,000 inhabitants/day (DDD) was determined. Citalopram was the fourth most frequently found drug in overdose, occurring in 22 (6%) of the 358 fatal poisoning cases, after dextropropoxyphene (DXP), flunitrazepam and nitrazepam, which were present in 111 (31%), 56 (16%) and 31 (9%) cases, respectively. When related to the prescription rate, citalopram was significantly less represented than five of the other seven included drugs, namely DXP, flunitrazepam, nitrazepam, amitriptyline and clomipramine. Propiomazine and zopiclone occurred to the same extent as citalopram. According to the assessments of the forensic physicians, citalopram was the cause of death in five cases (1.4%) and contributed to death in another nine cases (2.5%). It is concluded that citalopram, in spite of its high prescription rate, has not become a drug of importance in fatal poisoning cases. Since, this result may not be generalisable to non-fatal poisoning cases, it is recommended that the prevalence of citalopram in these cases be examined separately.
authors.affiliation: Department of Surgical Sciences/Forensic Medicine, University of Uppsala, Dag Hammarskjölds väg 17, S-752 37, Uppsala, Sweden. birgitta.jonasson@rfv.sfa.se
authors.forename: Birgitta
authors.initials: B
authors.lastname: Jonasson
authors.forename: Tom
authors.initials: T
authors.lastname: Saldeen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000506:poisoning*; D001344:Autopsy; D002423:Cause of Death; D015283:Citalopram / Q000097:blood / Q000506:poisoning*; D011431:Dextropropoxyphene / Q000506:poisoning; D005260:Female; D005445:Flunitrazepam / Q000506:poisoning; D006801:Humans; D008297:Male; D008875:Middle Aged; D009567:Nitrazepam / Q000506:poisoning; D011041:Poisoning / Q000453:epidemiology* / Q000209:etiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D017367:Selective Serotonin Reuptake Inhibitors / Q000506:poisoning*; D013548:Sweden / Q000453:epidemiology
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D011431:Dextropropoxyphene; D005445:Flunitrazepam; D009567:Nitrazepam; D017367:Selective Serotonin Reuptake Inhibitors