LoVecchio Frank, Riley Brad, Pizon Anthony, Brown Michael
Banner Good Samaritan Regional Poison Center, Phoenix, Arizona 85006, USA.
J Emerg Med. 2008 Jan;34(1):77-8. doi: 10.1016/j.jemermed.2007.03.006. Epub 2007 Jul 31.
Mirtazapine (Remeron) is a newly approved medication for the treatment of depression. It is an alpha(2)-adrenergic antagonist that causes increased levels of neuronal norepinephrine and serotonin. It is also believed to be an antagonist at the serotonin receptors 5-HT(2) and 5-HT(3). Little is known about isolated mirtazapine ingestions. We conducted a retrospective chart review of mirtazapine ingestions reported to our Poison Center during 2004. A standardized data sheet was completed collecting information regarding standard demographic data along with co-ingestants, neurologic and cardiovascular symptoms, and disposition. Data collection was reviewed by a second investigator, and a kappa score was calculated. Of 71 patients identified with mirtazapine ingestions, there were 33 isolated exposures that were further reviewed. A kappa score for inter-reviewer reliability was calculated and at 0.61, 95% confidence interval 56-70. The average age of these patients was 27 years (range 6-82 years), with the mean ingestion of 343 mg (range 15-1500 mg). The most common neurologic symptom was drowsiness seen in 8/23 patients, 1 patient became agitated, and 14 patients had no abnormal neurologic findings. Cardiovascular effects were recorded in 4/23 patients, with 3 patients exhibiting tachycardia and 1 patient with bradycardia and hypotension. Seven of 23 patients required admission; there were no deaths. Mirtazapine overdoses are generally very well tolerated, with the most common symptoms being drowsiness and lethargy. This study is limited by being a retrospective chart review.
米氮平（瑞美隆）是一种新批准用于治疗抑郁症的药物。它是一种α₂-肾上腺素能拮抗剂，可使神经元去甲肾上腺素和血清素水平升高。它也被认为是5-羟色胺受体5-HT₂和5-HT₃的拮抗剂。关于单独服用米氮平的情况知之甚少。我们对2004年向我们毒物中心报告的米氮平服用情况进行了回顾性病历审查。完成了一份标准化数据表，收集有关标准人口统计学数据以及合并摄入物质、神经和心血管症状及处置情况的信息。数据收集由另一位研究者进行审查，并计算了kappa评分。在确定的71例服用米氮平的患者中，有33例单独暴露情况进行了进一步审查。计算了审查者间可靠性的kappa评分，为0.61，95%置信区间为56 - 70。这些患者的平均年龄为27岁（范围6 - 82岁），平均摄入量为343毫克（范围15 - 1500毫克）。最常见的神经症状是嗜睡，23例患者中有8例出现，1例患者变得烦躁不安，14例患者无异常神经学表现。23例患者中有4例记录了心血管效应，3例患者出现心动过速，1例患者出现心动过缓和低血压。23例患者中有7例需要住院；无死亡病例。米氮平过量服用通常耐受性良好，最常见的症状是嗜睡和昏睡。本研究因是回顾性病历审查而受到限制。
