title: Fatal intoxication with milnacipran.
abstract: The antidepressant milnacipran is a double serotonin/noradrenalin reuptake inhibitor. The low reported incidence of intoxication indicates excellent tolerance in comparison with tricyclic and second generation antidepressants. We report a fatal intoxication associating milnacipran, at blood levels (femoral=21.5 mg/l, cardiac=20 mg/l) 40-fold higher than the usual treatment concentration, and six other molecules (fluoxetine, norfluoxetine, sertraline, cyamemazine, nordazepam and oxazepam) at therapeutic levels. To the best of our knowledge, this is the first reported fatal intoxication involving milnacipran.
authors.affiliation: Université Lyon 1, Institut de Médecine Légale, 12 Avenue Rockefeller Lyon, F-69008 Lyon, France. laurent.fanton@adm.univ-lyon1.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Fanton
authors.forename: Fabien
authors.initials: F
authors.lastname: Bévalot
authors.forename: Habdelhamid
authors.initials: H
authors.lastname: Grait
authors.forename: Catherine
authors.initials: C
authors.lastname: Le Meur
authors.forename: Yvan
authors.initials: Y
authors.lastname: Gaillard
authors.forename: Daniel
authors.initials: D
authors.lastname: Malicier
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000097:blood; D000928:Antidepressive Agents / Q000097:blood / Q000506:poisoning*; D002851:Chromatography, High Pressure Liquid; D003521:Cyclopropanes / Q000097:blood / Q000506:poisoning*; D005260:Female; D005473:Fluoxetine / Q000031:analogs & derivatives / Q000097:blood; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D000078764:Milnacipran; D003708:Nordazepam / Q000097:blood; D010076:Oxazepam / Q000097:blood; D010640:Phenothiazines / Q000097:blood; D017367:Selective Serotonin Reuptake Inhibitors / Q000097:blood; D020280:Sertraline / Q000097:blood; D013405:Suicide
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D003521:Cyclopropanes; D005473:Fluoxetine; D000078764:Milnacipran; D003708:Nordazepam; D010076:Oxazepam; D010640:Phenothiazines; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; C028457:cyamemazine; C036139:norfluoxetine