Related Experiment Videos
An uncommon fatality due to moclobemide and paroxetine
1Office of the Chief Medical Examiner, Edmonton, Alberta, Canada.
Abstract:
A young man was found shivering and incoherent at home. He was placed in bed and was observed having seizures some time later. About four hours after he was initially found, he suffered a full cardiac arrest. Paramedics found his jaw unusually stiff and were unable to open his mouth in order to intubate him. Resuscitation attempts were unsuccessful. The autopsy findings were unremarkable, but toxicology testing revealed the following: moclobemide (subclavian blood, 18.5 mg/L; liver, 28.5 mg/kg; gastric contents, 77 mg/69 g) and paroxetine (subclavian blood, 1.58 mg/L; liver, 15.3 mg/kg; gastric contents, 0.7 mg/69 g). The cause of death was attributed to the combined toxicity of moclobemide and paroxetine. Deaths attributed primarily to these drugs are extremely rare because both are considerably less toxic than older monoamine oxidase and tricyclic antidepressant drugs. Based on the history of the case and pharmacology of the drugs involved, the most likely mechanism of death was severe "serotonin syndrome" resulting from the overdose.
Insights
A rare case of fatal serotonin syndrome occurred in a young man due to an overdose of moclobemide and paroxetine. This combination, typically less toxic, led to cardiac arrest and death.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Medicine
Background:
- Serotonin syndrome is a potentially life-threatening condition associated with serotonergic drug use.
- Moclobemide (a reversible inhibitor of monoamine oxidase A) and paroxetine (a selective serotonin reuptake inhibitor) are antidepressants.
- Fatalities from these specific antidepressants are considered rare due to their generally lower toxicity compared to older agents.