title: Status epilepticus following intentional overdose of fluvoxamine: a case report with serum fluvoxamine concentration.
abstract: BACKGROUND
  Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) that is used in the management of depression and obsessive compulsive disorders. We report a patient with status epilepticus requiring quadruple anti-convulsant treatment following a fluvoxamine overdose.
  
  
  METHODS
  A 25-year-old female presented with drowsiness at 12 hours following deliberate ingestion of 9.6 grams of fluvoxamine. Sixteen hours after ingestion, she developed status epilepticus that required treatment with benzodiazepines (lorazepam and midazolam), thiopentone, phenytoin and phenobarbitone. Her serum fluvoxamine concentration on presentation was 1970 microg/L (therapeutic 160-220 microg/L) and routine toxicological screening was negative for other drugs. She was discharged home after 72 hours with no further episodes of seizures.
  
  
  CONCLUSIONS
  Most patients with fluvoxamine poisoning are either asymptomatic or may develop mild signs of serotonergic toxicity. Although serotonin syndrome and isolated seizures are reported in fluvoxamine poisoning, we report the first patient with confirmed isolated fluvoxamine toxicity who developed status epilepticus.
authors.affiliation: Guy's and St. Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. David.Wood@gstt.nhs.uk
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.forename: Yadhunanthanan
authors.initials: Y
authors.lastname: Rajalingam
authors.forename: Shaun L
authors.initials: SL
authors.lastname: Greene
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Morgan
authors.forename: David
authors.initials: D
authors.lastname: Gerrie
authors.forename: Alison L
authors.initials: AL
authors.lastname: Jones
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000097:blood / Q000506:poisoning*; D001463:Barbiturates / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D062787:Drug Overdose; D004359:Drug Therapy, Combination; D005260:Female; D016666:Fluvoxamine / Q000097:blood / Q000506:poisoning*; D006801:Humans; D011041:Poisoning / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D012640:Seizures / Q000139:chemically induced / Q000503:physiopathology; D013226:Status Epilepticus / Q000139:chemically induced* / Q000503:physiopathology; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D001463:Barbiturates; D001569:Benzodiazepines; D016666:Fluvoxamine