Status epilepticus following intentional overdose of fluvoxamine: a case report with serum fluvoxamine concentration.
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.
Wood
David M
DM
Guy's and St. Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. David.Wood@gstt.nhs.uk
Rajalingam
Yadhunanthanan
Y
Greene
Shaun L
SL
Morgan
Phillip E
PE
Gerrie
David
D
Jones
Alison L
AL
Dargan
Paul I
PI
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
D018687:Antidepressive Agents, Second-Generation; D001463:Barbiturates; D001569:Benzodiazepines; D016666:Fluvoxamine