Selective serotonin reuptake inhibitor toxicity

Background

• Most serious adverse effect is potential to produce Serotonin Syndrome
• Fatalities are uncommon with pure overdoses

Clinical Features

• Nausea and vomiting
• Sedation
• Tremor
• Sinus tachycardia
• QRS, QT prolongation (citalopram only)
• Serotonin syndrome

Differential Diagnosis

• Serotonin syndrome

Anticholinergic toxicity Causes

• Medications
  • Atropine
    • Lomotil toxicity
  • Antihistamines
  • Antidepressants
    • Tricyclic antidepressant (TCA) toxicity
    • Selective serotonin reuptake inhibitor toxicity
  • Antipsychotics
  • Muscle relaxants
  • Anti-Parkinsonians
• Plants
  • Jimson weed (Devil's trumpet)
  • Amanita mushroom

Treatment

• GI decontamination
  • Activated charcoal x1
  • Gastric lavage unnecessary

Disposition

• Consider admission for patients who are tachycardic or lethargic 6hr after ingesion

See Also

• Serotonin syndrome
• SNRI Toxicity

Source

Tintinalli