Fatal intoxication with milnacipran.
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.
Fanton
Laurent
L
Université Lyon 1, Institut de Médecine Légale, 12 Avenue Rockefeller Lyon, F-69008 Lyon, France. laurent.fanton@adm.univ-lyon1.fr
Bévalot
Fabien
F
Grait
Habdelhamid
H
Le Meur
Catherine
C
Gaillard
Yvan
Y
Malicier
Daniel
D
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
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