SSRI Toxicity Flashcards
Dose of SSRI associated w/ fatalities:
150x daily dose, or w/ presence of co-ingestants like benzos or alcohol.
Clinical presentation of SSRI toxicity includes:
N/V, dizziness, blurred vision, CNS depression, tachycardia, serotonin syndrome (altered mental status, agitation, tremor, diarrhea, muscle rigidity, seizures, ECG changes like increased QRS and QTc).
Safest SSRIs w/ respect to toxicities:
Fluoxetine, Sertraline, and Paroxetine.
SSRI w/ greatest potential for toxicity:
Citalopram. Ingestions
How to diagnose SSRI toxicity:
Routine labs to identify co-ingestants: fingerstick glucose, acetaminophen and ASA, ethanol levels, ECG, ABGs.
If serotonin syndrome: CK, SCr, LFTs, INR, and PT.
Note: serum drug [ ] not helpful.
How do you manage SSRI toxicity?
Largely supportive. Give dextrose and thiamine to patients w/ altered LOC.
How do you manage seizures in SSRI toxicity?
Use benzos.
Is there a role for hemodialysis in SSRI toxicity?
No.
How do you manage serotonin syndrome in SSRI toxicity?
Use supportive care & focus on decreasing muscle rigidity b/c this can lead to hyperthermia (use rapid external cooling & benzos). In severe cases, use neuromuscular blockade to achieve rapid muscle relaxation. May give single dose of serotonin antagonist cyproheptadine.
How do you manage QT prolongation in SSRI toxicity?
Give IV magnesium over 2 min and may repeat after 10min to prevent TdP.
What are the warning signs indicating increased risk of TdP in SSRI toxicity?
QT > 560msec, previous Hx of TdP, bradycardia, increased frequency of premature ventricular beats.
How do you monitor QT prolongation in SSRI toxicity?
Perform serial ECG q2-4h to make sure interval is not continuing to increase.
Can you use GI contamination (activated charcoal) in SSRI toxicity?
Yes. If patient presents in reasonable timeframe.
