Biphasic time-course of serum concentrations of clomipramine and desmethylclomipramine after a near-fatal overdose.

A 27-y-old male was admitted deeply comatosed 5-6 h after taking approximately 15 g clomipramine. The prominent feature of the case was a biphasic course of clomipramine and desmethylclomipramine serum concentrations, possibly caused by delayed drug absorption. Clinically, 2 serious episodes requiring mechanical ventilation and aggressive pressor agent infusions occurred as the serum concentrations declined. However, the severe adult respiratory distress syndrome--related inflammatory process that required 4 w of intensive care may also be an explanation, although blood cultures were negative and neither liver nor renal functions were severely compromised.