Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia.
Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, Australia.
Clin Toxicol (Phila). 2022 Sep;60(9):1019-1023. doi: 10.1080/15563650.2022.2083631. Epub 2022 Jun 6.
Duloxetine is a commonly used antidepressant that is a serotonin and norepinephrine reuptake inhibitor. We aimed to investigate the frequency and severity of clinical effects following duloxetine overdose.
We undertook a retrospective review of duloxetine overdoses (>120 mg) admitted to two tertiary toxicology units between March 2007 and May 2021. Demographic information, details of ingestion (dose, co-ingestants), clinical effects, investigations (ECG parameters including QT interval), complications (coma [GCS < 9], serotonin toxicity, seizures and cardiovascular effects), length of stay [LOS] and intensive care unit [ICU] admission were extracted from a clinical database.
There were 241 duloxetine overdoses (>120 mg), median age 37 years (interquartile range [IQR]: 25-48 years) and there were 156 females (65%). The median dose was 735 mg (IQR: 405-1200 mg). In 177 patients, other medications were co-ingested, most commonly alcohol, paracetamol, quetiapine, diazepam, ibuprofen, pregabalin and oxycodone. These patients were more likely to be admitted to ICU (12 [7%] vs. none; = 0.040), develop coma (16 [9%] vs. none; = 0.008) and hypotension [systolic BP < 90 mmHg] (15 [8%] vs. one; = 0.076). Sixty four patients ingested duloxetine alone with a median dose of 840 mg (180-4200 mg). The median LOS, in the duloxetine only group, was 13 h (IQR:8.3-18 h), which was significantly shorter than those taking coingestants, 19 h (IQR:12-31 h; = 0.004). None of these patients were intubated. Six patients developed moderate serotonin toxicity, without complications and one had a single seizure. Tachycardia occurred in 31 patients (48%) and mild hypertension (systolic BP > 140 mmHg) in 29 (45%). One patient had persistent sympathomimetic toxicity, and one had hypotension after droperidol. Two patients of 63 with an ECG recorded had an abnormal QT: one QT 500 ms, HR 46 bpm, which resolved over 3.5 h and a second with tachycardia (QT 360 ms, HR 119 bpm). None of the 64 patients had an arrhythmia.
Duloxetine overdose most commonly caused sympathomimetic effects and serotonin toxicity, consistent with its pharmacology, and did not result in coma, arrhythmias or intensive care admission, when taken alone in overdose.
度洛西汀是一种常用的抗抑郁药，属于 5-羟色胺和去甲肾上腺素再摄取抑制剂。我们旨在研究度洛西汀过量后的临床效应的频率和严重程度。
我们对 2007 年 3 月至 2021 年 5 月期间两家三级毒理学单位收治的 241 例度洛西汀（>120mg）过量患者进行了回顾性分析。从临床数据库中提取人口统计学信息、摄入细节（剂量、共服药物）、临床效应、检查（包括 QT 间期的心电图参数）、并发症（昏迷[GCS < 9]、血清素毒性、癫痫发作和心血管效应）、住院时间[LOS]和重症监护病房[ICU]入院情况。
共有 241 例度洛西汀（>120mg）过量，中位年龄为 37 岁（四分位距 [IQR]：25-48 岁），其中 156 例为女性（65%）。中位剂量为 735mg（IQR：405-1200mg）。在 177 例患者中，其他药物与度洛西汀同时服用，最常见的是酒精、对乙酰氨基酚、喹硫平、地西泮、布洛芬、普瑞巴林和羟考酮。这些患者更有可能被收入 ICU（12 例[7%]与无； = 0.040），发生昏迷（16 例[9%]与无； = 0.008）和低血压[收缩压 < 90mmHg]（15 例[8%]与 1 例； = 0.076）。64 例患者单独服用度洛西汀，剂量中位数为 840mg（180-4200mg）。在仅服用度洛西汀组中，中位 LOS 为 13 小时（IQR：8.3-18 小时），明显短于服用共服药物的患者（19 小时；IQR：12-31 小时； = 0.004）。这些患者均未插管。6 例患者出现中度血清素毒性，无并发症，1 例患者出现单发癫痫。31 例（48%）出现心动过速，29 例（45%）出现轻度高血压（收缩压>140mmHg）。1 例患者出现持续性拟交感神经毒性，1 例患者在使用氟哌啶醇后出现低血压。在记录心电图的 63 例患者中，有 2 例患者的 QT 异常：1 例 QT 500ms，HR 46bpm，3.5 小时后恢复正常，另 1 例患者出现心动过速（QT 360ms，HR 119bpm）。这 64 例患者均无心律失常。
度洛西汀过量最常见的是拟交感神经效应和血清素毒性，与度洛西汀的药理学一致，单独过量服用时不会导致昏迷、心律失常或入住重症监护病房。
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