Lamotrigine and Fluoxetine Overdose Presenting With Severe Neuro-Cardiotoxicity: A Case Report

Lamotrigine and fluoxetine are commonly prescribed for the treatment of bipolar disorder and anxiety. Combination therapy is used in resistant bipolar depression to improve synergy and tolerability. Although most cases of lamotrigine overdose have mild toxicity, in the case of massive ingestion of more than 4 g associated with severe neurological and cardiac complications, leading to mortality, either due to severe central nervous system depression, refractory seizures, or due to cardiac arrhythmia. We describe the case of a 28‑year‑old woman with bipolar disorder who developed status epilepticus, atrial fibrillation, aspiration pneumonia, and acute kidney injury after ingesting approximately 30 tablets of lamotrigine (6000 mg) and fluoxetine (600 mg). Her recovery was further complicated by dysphagia and vocal cord dysfunction. This report highlights the importance of prompt and intensive supportive care and draws attention to the potential for uncommon cranial nerve involvement following severe mixed‑drug intoxication.