Clinical and analytical features of severe suicidal quetiapine overdoses – a retrospective cohort study

Eyer, Florian; Pfab, Rudolf; Felgenhauer, Norbert; Strubel, Tim; Saugel, Bernd; Zilker, Thomas

doi:10.3109/15563650.2011.624100

Cited by 44 publications

(26 citation statements)

References 35 publications

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“…In a study of fatalities documented in postmarketing safety reports, Marder et al (43) found the frequency of respiratory effects was second only to cardiovascular effects for olanzapine. Two other reports found quetiapine to be associated with respiratory depression in severe cases (44,45). The following drugs included in this report were associated with at least 200 serious outcomes and with frequencies of respiratory depression .6%: doxepin (13.6%), amitriptyline (12.1%), pregabalin (11.3%), benzodiazepines (11.2%), imipramine (9.0%), quetiapine (8.0%), olanzapine (7.6%), and gabapentin (7.3%).…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Nelson

Spyker

2017

AJP

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Objective: The authors sought to determine the relative morbidity and mortality associated with drugs used to treat depression and to examine specific clinical effects associated with serious outcomes.Method: The National Poison Data System, which receives exposure reports from regional poison centers serving the United States, Puerto Rico, and the District of Columbia, was queried for single drug exposures in individuals 12 years and older during the period 2000-2014. Medications included were antidepressants, atypical antipsychotics, anticonvulsants, lithium, and other medications used in the treatment of depression. The main outcomes were the morbidity index (the number of serious outcomes per 1,000 exposures) and the mortality index (the number of fatal outcomes per 10,000 exposures).Results: During this 15-year period, there were 962,222 single substance exposures to the 48 medications studied. Serious outcomes rose 2.26-fold and in linear fashion over the 15 years. While tricyclic and monoamine oxidase inhibitor medications were associated with high morbidity and mortality, several newer agents also appeared hazardous. Lithium, quetiapine, olanzapine, bupropion, and carbamazepine were associated with high morbidity indices. Lithium, venlafaxine, bupropion, quetiapine, olanzapine, ziprasidone, valproic acid, carbamazepine, and citalopram were associated with higher mortality indices.Conclusions: Serious outcomes after overdose or nonintentional exposures to medications used to treat depression have risen dramatically over the past 15 years. The present data suggest that the morbidity and mortality risks vary substantially among these medications. These differences become important when selecting treatments for patients with depression, especially those at increased risk for suicide.

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Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Nelson

Spyker

2017

AJP

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“…Manche Patienten weisen ein anticholinerges Syndrom auf, das auf Physostigmin anspricht. Bei verlängerter QT-Zeit muss von einer Kardiotoxizität ausgegangen werden [14]. Eine besondere Gefahr geht von den Retardpräparaten aus mit über Tage ansteigenden Serumspiegeln.…”

Section: Vergiftungen Durch Quetiapin ▼unclassified

Akute Intoxikationen bei Erwachsenen – was Sie wissen sollten

Zilker¹

2014

Dtsch med Wochenschr

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Ingestion of household products and plants are the leading cause for calls to the poison control centres as far as children are involved. Severe intoxication in children has become infrequent due to childproofed package and blister packs for drugs. Chemical accidents in adults give rise to hospital admission in only 5 %. Suicidal selfpoisonings are still a challenge for paramedics, emergency and hospital doctors. Natural toxins as amatoxins, cholchicine and snakebites can lead to severe intoxication. Sedatives, antidepressants and analgesics are the drugs which are often used for suicidal intent due to their availability. Quetiapine and paracetamol are the drugs which are ingested for attempted suicide/ suicide mostly. The treatment of poisoning centers on the severity which can be judged by the poison severity score, the Reed classification or the GCS.Most intoxicated patients can be treated symptomatically or by intensive care measurements. Antidotal treatment however is needed for some specific poisonings.Exact sample drawing is essential for diagnostic and forensic purposes. There is no evidence based proof for the effectiveness of primary detoxification from the gastrointestinal tract like forced emesis, gastric lavage or the use of cathartics. Early after the ingestion of a harmful substance the administration of activated charcoal seems advisable. Hemodialysis can remove water soluble substances with a small volume of distribution. Multiple charcoal administration may exhibit some influence on secondary detoxification. Provision of evidence of the efficacy for newer antidotes like hydroxocobalamin in smoke inhalation, fomepizol for toxic alcohols and silibinin for amanita poisoning are emerging. Two recently recommended therapeutic principles have still to demonstrate their ability: Firstly the treatment of patients with calcium receptor antagonistic and beta-receptor antagonistic agents poisoning by high dose of insulin plus glucose, secondly the treatment for severe intoxication with cardiotoxic and psychotropic drugs with a lipid emulsion (Lipid rescue).It is essential for all doctors to contact a poison control center whenever they are confronted with an intoxicated patient. There they can get advice about which dose is toxic and about the newest therapeutic procedure.

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“…Manche Patienten weisen ein anticholinerges Syndrom auf, das auf Physostigmin anspricht. Bei verlängerter QT-Zeit muss von einer Kardiotoxizität ausgegangen werden [26]. Eine besondere Gefahr geht von den Retardpräparaten aus mit über Tage ansteigenden Serumspiegeln.…”

Section: Vergiftungen Durch Quetiapinunclassified

Akute Intoxikationen bei Erwachsenen – was Sie wissen sollten

Zilker¹

2014

Notarzt

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Ingestionsunfälle oder Chemieunfälle im Erwachsenenalter führen nur in 5 % der Fälle zu Krankenhausaufnahme. Suizidale Vergiftungen stellen jedoch eine Herausforderung für Rettungsdienst, Not-und Klinikärzte dar. Natürliche Toxine wie das Gift des Knollenblätterpilzes, der Herbstzeitlose oder Schlangenbisse können schwere Vergiftungen hervorrufen. Durch die Griffnähe von Schlafmitteln, Antidepressiva und Schmerzmitteln werden diese Medikamente häufig für suizidale Handlungen verwendet. Die Statistik der Giftinformationszentralen weist auf, das Quetiapin und Paracetamol in Deutschland am häufigsten für Suizidversuche/Suizide gebraucht werden. Die Therapie der Vergiftung richtet sich nach verschiedenen Schweregradkategorien (PSS, Reed und GCS). Meist reichen symptomatische oder intensivmedizinische Maßnahmen aus, um eine Vergiftung zu behandeln. Für etliche Vergiftungen ist jedoch eine Antidottherapie entscheidend. Eine korrekte Asservierung ist aus diagnostischen und forensischen Gründen unverzichtbar. Für die Wirksamkeit der meisten primären Giftentfernungsmaßnahmen (Erbrechen auslösen, Magenspülung, und Abführmittel) gibt es keinen evidenzbasierten Nachweis. Der Einsatz von Medizinalkohle sehr früh nach der Ingestion einer schädigenden Substanz ist noch ratsam. Die repetitive perorale Gabe von Medizinalkohle hat möglicherweise für die sekundäre Giftelimination noch eine gewisse Bedeutung. Gut wasserlösliche Substanzen mit kleinem Verteilungsvolumen lassen sich durch Hämodialyse entfernen. Für neuere Antidote wie Hydroxocobalamin bei der Rauchgasvergiftung, Fomepizol bei der Vergiftung durch toxische Alkohole und Silibinin bei der Knollenblätterpilzvergiftung zeichnet sich ein Wirksamkeitsnachweis ab. Zwei neue Therapieprinzipien müssen ihre Wirksamkeit noch unter Beweis stellen. Zum einen gilt dies für die Therapie von schweren Vergiftungen durch Kalziumkanalantagonisten und Betarezeptorenblockern mit hohen Dosen Insulin plus Glukose. Zum anderen scheint bei schweren Vergiftungen durch Kardiologika oder Psychopharmaka die Infusion einer Fettemulsion (Lipid rescue) in manchen Fällen wirksam zu sein. Bei jedem Vergiftungsfall ist es für Ärzte sinnvoll, eine Giftinformationszentrale einzuschalten, da dort über toxische Dosen der einzelnen Substanzen und über die neuesten Therapieverfahren Auskunft erteilt wird.Abstract ! Chemical accidents in adults give rise to hospital admission in only 5 %. Suicidal selfpoisonings are still a challenge for paramedics, emergency and hospital doctors. Natural toxins as amatoxins, cholchicine and snakebites can lead to severe intoxication. Sedatives, antidepressants and analgesics are the drugs which are often used for suicidal intent due to their availability. Quetiapine and paracetamol are the drugs which are ingested for attempted suicide/suicide mostly.

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Clinical and analytical features of severe suicidal quetiapine overdoses – a retrospective cohort study

Abstract: In this study, quetiapine overdoses were associated with significant toxicity and a fairly high number of complications. A careful and often prolonged clinical observation in the more severe cases of overdose seems mandatory.

Cited by 44 publications

References 35 publications

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Akute Intoxikationen bei Erwachsenen – was Sie wissen sollten

Akute Intoxikationen bei Erwachsenen – was Sie wissen sollten

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