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Fatality related to a 30-g
venlafaxine overdose.
Mazur JE, Doty JD, Krygiel
AS.
Department of Pharmacy Services College of Pharmacy,
Medical University of South Carolina, Charleston, South Carolina 29425,
USA. mazurj@musc.edu
A 30-g venlafaxine overdose resulted in
death for a 39-year-old woman whose 43-day clinical course was
highlighted by refractory hypotension and the resulting complications of
bowel ischemia and perforation. Her venlafaxine and
O-desmethylvenlafaxine levels, analyzed by high-performance liquid
chromatography one day after ingestion, were 21.82 mg/L (therapeutic
range 0.1-0.5 mg/L) and 3.33 mg/L (0.2-0.4 mg/L), respectively. These
levels remained elevated for over 7 days. Postulated explanations for
these extended elevated levels were saturation of drug metabolism,
decreased drug metabolism, and existence of a genetic polymorphism. Our
patient's venlafaxine overdose produced a wide variety of clinical
challenges, to include seizures, tachycardia, decreased level of
consciousness, refractory hypotension, and bowel dysmotility. In
addition, this case augments the growing body of literature that
suggests that venlafaxine may be fatal in overdose
situations.
PMID: 14695048 [PubMed - in process]
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