title: Intoxications with the monoamine oxidase inhibitor tranylcypromine: an analysis of fatal and non-fatal events.
abstract: Tranylcypromine (TCP) is a non-selective and irreversible monoamine oxidase inhibitor and an effective agent in the treatment of major depression. It features a complex pharmacologic profile and overdoses might induce severe intoxications. To identify typical clinical presentations of TCP-intoxications, range of associated TCP-dosages and possible differences between fatal and non-fatal intoxications a systematic review of all previously published cases of TCP-intoxications was conducted. We detected n=20 reports of TCP-intoxications in the literature (fatalities n=10). Mean age was 36.7 years (median 37); the majority of patients were female (60%). Frequent findings in patients with TCP-intoxications were disturbance of consciousness/cognitive dysfunction (90%), cardio-vascular symptoms (55%), hyperthermia (50%), respiratory distress (45%), delirium (45%), muscular rigidity (30%) and renal failure (20%). Suicidal intent was present in n=18 (90%) patients. First clinical symptoms related to TCP-intoxication developed on average in less than 1 day. The average dosage related to TCP-intoxication was 677 mg. The highest survived TCP-dosage was 4000 mg and the lowest fatal dosage was 170 mg. Patients with fatal intoxications were on average older (40.5 vs. 32.8 years) and developed a more rapid onset of symptoms (0.2 vs. 0.8 days). Death occurred after a mean time of 0.6 days; symptom relief in patients with non-fatal intoxications developed on average after 3.2 days. Considering the large dose spectrum between survived and lethal TCP-dosages individual susceptibility factors might play a role regarding the severity of clinical symptoms independently of the ingested dosage.
authors.affiliation: Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany. Electronic address: maximilian.gahr@uni-ulm.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Gahr
authors.forename: Carlos
authors.initials: C
authors.lastname: Schönfeldt-Lecuona
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kölle
authors.forename: Roland W
authors.initials: RW
authors.lastname: Freudenmann
mesh_terms: D003865:Major Depressive Disorder / Q000188:drug therapy / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects*; D014191:Tranylcypromine / Q000009:adverse effects*
chemical_list: D008996:Monoamine Oxidase Inhibitors; D014191:Tranylcypromine
keywords: Adverse events; Antidepressants; Major depression; Psychopharmacology; Suicide; Toxicology