Fatal overdose with citalopram

The Department of Forensic Medicine at Umea University in Sweden reported on six forensically investigated suicides where overdose with the SSRI citalopram was found. In all cases, a strong evidence of acute overdose was found, and the forensic investigation did not reveal other causes or modes of death. The post-mortem concentrations of citalpram in the blood were between 5.2-49 micrograms. For comparison, in 335 other post-mortem blood analysis performed among non-overdose deaths, post mortem citalopram concentrations varied between 0.06 and 7.0 micrograms. The therapeutic concentration in post-mortem blood has been reported to be 0.3 micrograms, which is well below the concentrations in their cases. One possible mechanism of death is cardiac arrhythmias. Citalopram prolongs the QT interval. In a recent report to the Swedish Medical Products Agency the QT interval increased to 0.504 is a woman after overdose with citalopram. Seizures represent another mechanism of death, which cannot be completely ruled out. Until further study of citalopram toxicity is done the team in Sweden recommended the same precautions in prescription of citalopram as with tricyclic antidepressants to patients with a high risk of suicide.

The Lancet August 1996

Ostam, Mats; Eriksson, Anders; Thorson, Jan; Spigset, Olav

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