Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA.
J Med Toxicol. 2011 Dec;7(4):312-6. doi: 10.1007/s13181-011-0167-1.
Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor, recently approved for use in the USA for treatment of fibromyalgia. This case report describes a 59-year-old woman who ingested 3,000 mg of milnacipran in a suicide attempt. Following the ingestion, she became obtunded and developed autonomic instability. She required mechanical ventilation, treatment for hypertension, and then ultimately vasopressor support for refractory hypotension. In addition, she developed a transient, acute cardiac dysfunction with global hypokinesis and an ejection fraction of 30%. Resolution of the cardiac dysfunction was documented on repeat echocardiogram 2 days after the initial study. This was confirmed by cardiac catheterization performed 4 days after the acute ingestion in which coronary arteriogram was normal and left ventricular ejection fraction was 70%. Acute overdose was confirmed by quantification of plasma milnacipran concentration of 8,400 ng/mL obtained 5 h post-ingestion. To our knowledge, this represents the first case of cardiac toxicity complicating a milnacipran overdose in the medical literature.
米那普仑是一种选择性 5-羟色胺和去甲肾上腺素再摄取抑制剂，最近被批准用于美国治疗纤维肌痛。本病例报告描述了一位 59 岁女性，试图自杀时摄入了 3000 毫克米那普仑。摄入后，她变得迟钝，并出现自主神经不稳定。她需要机械通气、治疗高血压，随后因难治性低血压需要血管加压支持。此外，她还出现了短暂的急性心功能障碍，表现为全心运动功能减退和射血分数为 30%。在初始检查后 2 天的重复超声心动图上记录到心功能障碍的缓解。4 天后进行的急性摄入后心脏导管检查证实了这一点，冠状动脉造影正常，左心室射血分数为 70%。通过摄入后 5 小时获得的 8400ng/ml 的血浆米那普仑浓度定量确认了急性过量。据我们所知，这是医学文献中首例米那普仑过量引起的心脏毒性的病例。
