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[Intoxication with a tricyclic antidepressant].

S G Sakka1, F Kuethe, U Demme

  • 1Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Ostmerheimerstr. 200, 51109 Köln. SakkaS@Kliniken-Koeln.de

Der Anaesthesist
|April 28, 2007
PubMed
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This case report highlights a severe doxepin overdose where hemoperfusion showed limited efficacy in reducing toxic blood concentrations, despite initial improvements. The patient experienced recurrent seizures and required prolonged ventilation due to doxepin re-distribution.

Area of Science:

  • Toxicology
  • Pharmacology
  • Emergency Medicine

Background:

  • Tricyclic antidepressant (TCA) overdose can lead to severe toxicity.
  • Doxepin is a TCA used for depression and anxiety.
  • Managing TCA overdose requires careful monitoring and intervention.

Observation:

  • A 48-year-old woman presented with coma and seizures after ingesting approximately 4000 mg of doxepin and 100 mg of zolpidem.
  • Initial doxepin blood concentration was 1.2 microg/ml, with no life-threatening arrhythmias.
  • Hemoperfusion was performed, initially lowering doxepin levels, but re-distribution led to increased concentrations and recurrent seizures.

Findings:

  • Hemoperfusion temporarily reduced doxepin levels but did not prevent clinical deterioration due to re-distribution.

Related Experiment Videos

  • The patient required prolonged mechanical ventilation and experienced recurrent seizures.
  • Doxepin blood concentrations remained elevated for several days despite extracorporeal elimination.

    • Implications:

    • This case questions the effectiveness of hemoperfusion in managing severe doxepin intoxication, particularly when re-distribution is a significant factor.
    • The findings suggest that intensive supportive care remains crucial in doxepin overdose.
    • Further research is needed to optimize treatment strategies for severe TCA poisoning.