title: A Non-Fatal Self-Poisoning Attempt with Sildenafil.
abstract: The phosphodiesterase type 5 inhibitor, sildenafil, is not generally known for its use as a self-poisoning drug. However, intoxication cases with lethal outcome have been described. The case presented here is of a 56-year-old man who claimed to have undertaken an unsuccessful suicide attempt by mono-ingestion of 65 tablets of 100 mg sildenafil. He arrived at the emergency department 24 h after intake with severe vomiting and symptoms of blurred vision. Clinical examination revealed no priapism. Of note was a sinus tachycardia of 100 bpm without signs of hypotension. To quantify the sildenafil concentration in serum, an high-performance liquid chromatography photo-diode array method was developed and validated according to European Medicines Agency guidelines. The intoxicated patient had a serum concentration of 22.2 µg/mL sildenafil, at the time of presentation, which is far above the therapeutic peak concentration. The serum concentration further declined to 9.2 and 2.3 µg/mL, respectively, 5 and 14 h later, revealing a biological half-life of 4.2 h. To the best of our knowledge, this patient took the highest sildenafil dose, which resulted in the highest serum concentration, ever reported. In this subject, sildenafil showed good tolerability because few symptoms occurred and only moderate supportive therapy was needed for full recovery without sequelae.
authors.affiliation: Laboratory of Toxicology, Ziekenhuis Netwerk Antwerpen, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium veerle.matheeussen@gmail.com.
authors.forename: Veerle
authors.initials: V
authors.lastname: Matheeussen
authors.affiliation: Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
authors.forename: Kristof E
authors.initials: KE
authors.lastname: Maudens
authors.affiliation: Emergency Department, Ziekenhuis Netwerk Antwerpen, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: Anseeuw
authors.affiliation: Laboratory of Toxicology, Ziekenhuis Netwerk Antwerpen, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
authors.forename: Hugo
authors.initials: H
authors.lastname: Neels
mesh_terms: D002851:Chromatography, High Pressure Liquid; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis*; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D000068677:Sildenafil Citrate / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D015813:Substance Abuse Detection / Q000379:methods; D013406:Suicide, Attempted
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000068677:Sildenafil Citrate