The Use of Extracorporeal Life Support in a Patient Suffering from Venlafaxine Intoxication. A Case Report

Christoph Marquetand; Harald F. Langer; Jan Philipp Klein; Tobias Graf

doi:10.2478/jccm-2020-0014

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The Use of Extracorporeal Life Support in a Patient Suffering from Venlafaxine Intoxication. A Case Report

The Journal of Critical Care Medicine

Volume 6 (2020): Issue 2 (April 2020)

By: Christoph Marquetand, Harald F. Langer, Jan Philipp Klein and Tobias Graf

Open Access

|May 2020

Abstract

Very few reports exist on serious cardiac complications associated with intake of serotonin-noradrenaline reuptake inhibitors. This paper describes and discusses the case of a patient who ingested a dose of 17.5 g venlafaxine. She developed a full serotonergic syndrome leading to multi-organ failure, including refractory cardiovascular shock, which was managed by early implantation of an extracorporeal life support (ECLS) system as a bridging strategy. This intervention was successful and resulted in full recovery of the patient.

References

Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018;391:1357–66.
Search in Google Scholar Back to article
Schroeder I, Zoller M, Angstwurm M, Kur F, Frey L. Venlafaxine intoxication with development of takotsubo cardiomyopathy: Successful use of extracorporeal life support, intravenous lipid emulsion and CytoSorb®. Int J Artif Organs 2017;40:358–60.
Search in Google Scholar Back to article
Mazur JE, Doty JD, Krygiel AS. Fatality Related to a 30-g Venlafaxine Overdose. Pharmacotherapy 2003;23:1668–72.
Search in Google Scholar Back to article
Thomas A, Ovakim D, Kanji H, Dewar L, Finlayson G. Intravenous Lipid Emulsion Therapy and VA-ECMO rescue therapy for Massive Venlafaxine and Clonazepam Overdose. J Clin Toxicol 2017;07.
Search in Google Scholar Back to article
Vasudev R, Rampal U, Patel H, Patel K, Bikkina M, Shamoon F. Selective Serotonin-norepinephrine Reuptake Inhibitors-induced Takotsubo Cardiomyopathy. N Am J Med Sci 2016;8:312–5.
Search in Google Scholar Back to article
Ueyama T, Kasamatsu K, Hano T, Yamamoto K, Tsuruo Y, Nishio I. Emotional stress induces transient left ventricular hypocontraction in the rat via activation of cardiac adrenoceptors: a possible animal model of “tako-tsubo” cardiomyopathy. Circ J 2002;66:712–3.
Search in Google Scholar Back to article
Batista M, Dugernier T, Simon M, Haufroid V, Capron A, Fonseca S, et al. The spectrum of acute heart failure after venlafaxine overdose. Clin Toxicol 2013;51:92–5.
Search in Google Scholar Back to article
Godkar D, Stensby J, Sinnapunayagam S, Niranjan S. Venlafaxine induced acute myocardial infarction with normal coronary arteries. Am J Ther 2009;16:365–6.
Search in Google Scholar Back to article
Ellison GM, Torella D, Karakikes I, Purushothaman S, Curcio A, Gasparri C, et al. Acute beta-adrenergic overload produces myocyte damage through calcium leakage from the ryanodine receptor 2 but spares cardiac stem cells. J Biol Chem 2007;282:11397–409.
Search in Google Scholar Back to article
Khalifa M, Daleau P, Turgeon J. Mechanism of sodium channel block by venlafaxine in guinea pig ventricular myocytes. J Pharmacol Exp Ther 1999;291:280–4.
Search in Google Scholar Back to article
Fischer M, Unterecker S, Pfuhlmann B. Overdose of Venlafaxine with Mild Outcome. Neurosci Med 2012;03:327–9.
Search in Google Scholar Back to article
Christoph M, Ebner B, Stolte D, Ibrahim K, Kolschmann S, Strasser RH, et al. Broken heart syndrome: Tako Tsubo cardiomyopathy associated with an overdose of the serotonin-norepinephrine reuptake inhibitor Venlafaxine. Eur Neuropsychopharmacol 2010;20:594–7.
Search in Google Scholar Back to article
De Roock S, Beauloye C, De Bauwer I, Vancraynest D, Gurne O, Gerber B, et al. Tako-tsubo syndrome following nortriptyline overdose. Clin Toxicol 2008;46:475–8.
Search in Google Scholar Back to article
Lee WM. Drug-induced hepatotoxicity. N Engl J Med 2003;349:474–85.
Search in Google Scholar Back to article
Christensen RC, Garces LK. Hepatotoxic effects with high-dose venlafaxine. Psychiatry (Edgmont) 2006;3:10–1.
Search in Google Scholar Back to article
Long C, Crifasi J, Maginn D, Graham M, Teas S. Comparison of analytical methods in the determination of two venlafaxine fatalities. J Anal Toxicol 1997;21:166–9.
Search in Google Scholar Back to article
EFFEXOR XR (venlafaxine hydrochloride) Overdosage | Pfizer Medical Information - Canada n.d. https://www.pfizermedicalinformation.ca/en-ca/effexor-xr/overdosage# (accessed January 12, 2020).
Search in Google Scholar Back to article
Perry PJ. Psychotropic drug handbook. Lippincott Williams & Wilkins; 2007. P. 171.
Search in Google Scholar Back to article
Lee HMD, Archer JRH, Dargan PI, Wood DM. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol 2015;53:145–50.
Search in Google Scholar Back to article
Hayes BD, Gosselin S, Calello DP, Nacca N, Rollins CJ, Abourbih D, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin Toxicol (Phila) 2016;54:365–404.
Search in Google Scholar Back to article
Cole JB, Stellpflug SJ, Engebretsen KM. Asystole immediately following intravenous fat emulsion for overdose. J Med Toxicol 2014;10:307–10.
Search in Google Scholar Back to article
Rogatzki MJ, Ferguson BS, Goodwin ML, Gladden LB. Lactate is always the end product of glycolysis. Front Neurosci 2015;9.
Search in Google Scholar Back to article
Eldem İ, Kendirli T, Azapağası E, Özdemir G, Yıldız Ç, Yılmaz MM, et al. Venlafaxine intoxication in an adolescent presenting with severe lactic acidosis. Turk J Pediatr 2016;58:200–2.
Search in Google Scholar Back to article
Shekar K, Roberts JA, Mcdonald CI, Fisquet S, Barnett AG, Mullany D V., et al. Sequestration of drugs in the circuit may lead to therapeutic failure during extracorporeal membrane oxygenation. Crit Care 2012;16.
Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/jccm-2020-0014 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 120 - 123

Submitted on: Jul 22, 2019

Accepted on: Feb 26, 2020

Published on: May 6, 2020

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

ECLS,

ECMO,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2020 Christoph Marquetand, Harald F. Langer, Jan Philipp Klein, Tobias Graf, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 6 (2020): Issue 2 (April 2020)