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Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression

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Coma after overdose with duloxetine.

Maartje K Kruithof¹, Nynke A Bruins, Eric N van Roon

¹Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, Netherlands.

The Annals of Pharmacotherapy

|December 24, 2010

Summary

Duloxetine overdose can lead to delayed-onset coma, as seen in a patient who became unconscious six hours after ingestion. Symptoms resolved within 12 hours, highlighting the importance of monitoring after a serotonin-norepinephrine reuptake inhibitor overdose.

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Area of Science:

Pharmacology
Clinical Toxicology

Background:

Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is commonly prescribed for depression and neuropathic pain.
Serotonin syndrome and other adverse effects are known risks associated with SNRIs.

Observation:

A 49-year-old male presented after a significant duloxetine overdose.
Initial presentation included drowsiness, progressing to unconsciousness (Glasgow Coma Score 7) six hours post-ingestion.
The patient experienced urinary retention and a delayed coma onset, with recovery within 12 hours.

Findings:

Toxicologic screening confirmed a high plasma duloxetine concentration (0.86 mg/L).
The calculated plasma half-life of duloxetine was 18 hours, within the reference range.
The Naranjo probability scale indicated duloxetine as the probable cause of the patient's symptoms.

Implications:

This case underscores that duloxetine overdose can induce delayed-onset coma.
Rapid reversal of symptoms suggests a manageable toxicity profile with appropriate monitoring and supportive care.
Clinicians should be aware of the potential for delayed central nervous system depression following duloxetine overdose.