title: Newer antidepressants: evaluation of fatal toxicity index and interaction with alcohol based on Finnish postmortem data.
abstract: Finnish postmortem toxicology data from 1995 to 2002 was analyzed to obtain improved estimates of fatal toxicity indices for the newer antidepressants and to evaluate their interaction with alcohol. Altogether 284 fatal poisonings were attributed to 12 different newer antidepressants. Venlafaxine, mianserin, moclobemide, and mirtazapine were responsible for significantly more deaths than expected from their sales. Their fatal toxicity indices were higher than those of selective serotonin reuptake inhibitors (SSRIs) but lower than those of tricyclic antidepressants. In fatal poisonings involving alcohol in combination with venlafaxine, mianserin, moclobemide, or mirtazapine, the median blood alcohol concentration (BAC) ranged from 2.35 to 2.7 mg/g, whereas in those involving alcohol in combination with citalopram or fluoxetine the median BAC was 2.9 and 3.4 mg/g, respectively. The BAC was significantly lower in venlafaxine-related deaths than in those involving fluoxetine or citalopram. We conclude that among the newer antidepressants differences are present both in toxicity and in interaction potential with alcohol. The SSRIs appear to present a low risk of fatal poisoning when taken alone or in combination with alcohol, whereas venlafaxine is associated with an elevated risk.
authors.affiliation: Laboratory of Toxicology, Department of Forensic Medicine, P.O. Box 40, 00014 University of Helsinki, Finland. anna.koski@iki.fi
authors.forename: Anna
authors.initials: A
authors.lastname: Koski
authors.forename: Erkki
authors.initials: E
authors.lastname: Vuori
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ojanperä
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000097:blood / Q000506:poisoning*; D002492:Central Nervous System Depressants / Q000097:blood / Q000506:poisoning*; D004347:Drug Interactions; D000431:Ethanol / Q000097:blood / Q000506:poisoning*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005554:Forensic Medicine; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000097:blood / Q000506:poisoning*; D013405:Suicide / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents; D002492:Central Nervous System Depressants; D000431:Ethanol; D017367:Selective Serotonin Reuptake Inhibitors
references.citation: Int J Legal Med. 1998;111(4):188-90
references.pmid: 9646161
references.citation: QJM. 2003 May;96(5):369-74
references.pmid: 12702786
references.citation: BMJ. 2002 Dec 7;325(7376):1332-3
references.pmid: 12468481
references.citation: Br J Psychiatry. 2004 Jan;184:41-7
references.pmid: 14702226
references.citation: Duodecim. 1999;115(14):1531-5
references.pmid: 11912642
references.citation: Clin Pharmacol Ther. 2004 Mar;75(3):234-41
references.pmid: 15001975
references.citation: J Clin Psychiatry. 1998;59 Suppl 15:42-8
references.pmid: 9786310
references.citation: Clin Pharmacokinet. 1997;32 Suppl 1:1-21
references.pmid: 9068931
references.citation: BMJ. 2003 Mar 15;326(7389):600
references.pmid: 12637414
references.citation: J Forensic Sci. 1989 Sep;34(5):1116-27
references.pmid: 2809542
references.citation: Alcohol Clin Exp Res. 2002 Jul;26(7):956-9
references.pmid: 12170103
references.citation: J Clin Psychiatry. 2004;65 Suppl 4:25-30
references.pmid: 15046538
references.citation: J Clin Psychopharmacol. 1997 Jun;17(3):149-55
references.pmid: 9169957
references.citation: Hum Exp Toxicol. 2004 Jul;23(7):331-7
references.pmid: 15311850
references.citation: Acta Psychiatr Scand Suppl. 2000;403:17-25
references.pmid: 11019931
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2004 May;28(3):435-51
references.pmid: 15093950
references.citation: Br Med Bull. 2001;57:161-78
references.pmid: 11719915
references.citation: Eur J Clin Pharmacol. 2004 May;60(3):221-4
references.pmid: 15083251
references.citation: Forensic Sci Int. 2004 Jun 30;143(1):53-9
references.pmid: 15177630
references.citation: Eur Neuropsychopharmacol. 2000 Mar;10(2):133-42
references.pmid: 10706996
references.citation: J Anal Toxicol. 2000 Jan-Feb;24(1):46-53
references.pmid: 10654569
references.citation: Hum Exp Toxicol. 2003 May;22(5):281-7
references.pmid: 12774892
references.citation: J Affect Disord. 1998 Sep;50(2-3):225-33
references.pmid: 9858081
references.citation: Br Med J (Clin Res Ed). 1987 Oct 24;295(6605):1021-4
references.pmid: 3690249
references.citation: J Clin Psychiatry. 1997;58 Suppl 6:26-31
references.pmid: 9227670
references.citation: J Toxicol Clin Toxicol. 2004;42(1):67-71
references.pmid: 15083939
references.citation: BMJ. 1995 Jan 28;310(6974):221-4
references.pmid: 7866123