Keywords
fever
non-tricyclic antidepressant
poisoning
serotonin reuptake inhibitor
serotonin syndrome
How to Cite
Abstract
Incidence of acute poisoning with non-tricyclic antidepressants including serotonin reuptake inhibitors (SRIs) is increasing due to the enhanced prescriptions of these drugs that largely replaced the tricyclic antidepressants. SRIs are responsible for serotonin syndrome and risk of seizures. Cardiotoxicity is limited to enhanced QT length with the risk of torsade-de-pointes, mainly with citalopram. Dysfunction of ventricular conduction is exceptional and related to high doses of venlafaxine and citalopram. In a SRI-exposed patient exhibiting hyperthermia, the serotonin origin of fever should be questioned and fever not easily attributed to aspiration pneumonia due to the risk of multiorgan failure and the requirement of specific treatment to improve outcome. Management of SRI poisoning is supportive and based on benzodiazepines. In case of life-threatening fever, external cooling and muscle paralyzing agents used in combination with sedation and mechanical ventilation are indicated. To date, cyproheptadine is considered as the first-line antidote to treat serotonin syndrome.
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