[Poisoning with antidepressants].
Intoxications with medications are among the most frequent diagnoses in patients admitted to medical emergency departments and intensive care units. Due to their particular toxicity tricyclic antidepressants play an important role despite a decreasing incidence. Tricyclic antidepressant toxicity includes an inhibition of myocardial excitability, central (sedation, seizures) and peripheral anticholinergic signs, and arterial hypotension. Cardiac arrhythmia including ventricular tachycardia and fibrillation, sustained seizures and severe central anticholinergic symptoms such as agitation, delirium, and hyperthermia, are life threatening. Important treatment options include gastrointestinal decontamination with oral single-dose activated charcoal within 1-2 hours post ingestion, and antidotal therapy with boluses of sodium bicarbonate for cardiotoxicity. The selective serotonin reuptake inhibitors (SSRI) and the atypical antidepressants are far less toxic than tricyclics. They may lead to serotonin toxicity (serotonin syndrome).
Bodmer
Michael
M
Notfallstation und Abteilung für Klinische Pharmakologie und Toxikologie, Kantonsspital Basel, Basel. bodmerm@uhbs.ch
D000928:Antidepressive Agents / Q000493:pharmacokinetics / Q000506:poisoning*; D018687:Antidepressive Agents, Second-Generation / Q000493:pharmacokinetics / Q000506:poisoning; D000929:Antidepressive Agents, Tricyclic / Q000493:pharmacokinetics / Q000506:poisoning; D002319:Cardiovascular System / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography / Q000187:drug effects; D004630:Emergencies; D006207:Half-Life; D006801:Humans; D008657:Metabolic Clearance Rate; D020230:Serotonin Syndrome / Q000209:etiology / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000493:pharmacokinetics / Q000506:poisoning; D014218:Triage
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors