Five-year multicenter retrospective review of cyclobenzaprine toxicity

Spiller, Henry A.; Winter, Mark L.; Mann, Katherine V; Borys, Douglas J.; Muir, Scott; Krenzelok, Edward P.

doi:10.1016/0736-4679(95)02019-5

“…It is possible that a larger sample size collected over several more years could capture patients with dysrhythmias or seizures, if they were to occur. However, our data suggest the risk of these adverse effects are less than 0.5% and is consistent with previous reports [10,17]. Our data were collected from Texas; results could vary in other geographic regions, although, cyclobenzaprine use is ubiquitous and our results are consistent with reports from outside Texas.…”

Section: Discussionsupporting

confidence: 83%

“…In animal models, it also has some antiepileptic effects ,which is consistent with its possible antispastic effects [20]. Second, one tablet is 10 mg, thus, intentional ingestions greater than 1 g are difficult to achieve, and cardiotoxic and neurotoxic doses are not ingested [10,15]. However, several cases of 1 to 3 g have been reported without seizures and dysrhythmia, thus, the lack of toxicity is likely a combination of mechanisms-a lack of potency and insufficient dose.…”

Section: Discussionmentioning

confidence: 80%

“…In several cases of cyclobenzaprine overdose, seizure, dysrhythmia, and hypotension were not reported [14,15]. In the series by Dr Spiller [10] of undifferentiated unintentional and intentional cases of all ages reported to several poison centers, no patient developed ventricular dysrhythmia or seizure, and no patient died. These results were similar to ours.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

Bebarta

¹

,

Maddry

²

,

Borys

³

et al. 2011

The American Journal of Emergency Medicine

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Background: The cyclobenzaprine structure is similar to amitriptyline; however, tricyclic antidepressant (TCA)-like wide complex dysrhythmia has not been reported. Our objective was to determine the incidence of TCA-like effects in cyclobenzaprine overdoses as reported to 6 poison centers for 2 years. We compared the incidence of these effects to amitriptyline overdoses collected during the same period. Methods: We performed a retrospective review of 2 years of cases as reported to the Texas Poison Center Network. We identified sole ingestions of cyclobenzaprine and of amitriptyline. Cases had a recorded clinical outcome and clinical effect. A trained reviewer used a standard data collection sheet within a secured electronic database. One investigator audited a random sample of charts. Results: We identified 3974 cases of cyclobenzaprine calls. Of these, we collected 209 cases of acute overdoses without coingestions. There were no deaths. No cases of cyclobenzaprine ingestions were reported to have died or have a wide QRS or ventricular dysrhythmia. Seizures were reported in 2 cases; however, both were unrelated to cyclobenzaprine. Hypotension was reported in 1.4% (3/209) of cases, and a vasopressor was used in one case (0.5%). Patients with an amitriptyline overdose were more likely to have seizure, coma, tachycardia, a wide QRS or ventricular dysrhythmia, and have received sodium bicarbonate or be intubated. Conclusions: Cyclobenzaprine overdoses were not reported to cause widened QRS, ventricular dysrhythmias, or seizures, and hypotension was rarely reported. Tricyclic antidepressant-related effects occurred more often in our comparison group of amitriptyline overdoses.

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“…Although the toxic dose of cyclobenzaprine is not known, patients with acute ingestions ranging from 260 to 900 mg have survived (Spiller et al, 1995). Clinical manifestations following an acute toxic ingestion may be consistent with anticholinergic toxicity (Bebarta et al, 2011).…”

Section: Management Of Cyclobenzaprine Toxicitymentioning

confidence: 98%

Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose

Westrol

¹

,

Awad

²

,

Bridgeman

³

et al. 2015

Therapeutic Hypothermia and Temperature Management

5

0

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In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose of cyclobenzaprine. During transport, the patient developed cardiac arrest. He received active rewarming measures, including pleural lavage, gastric lavage, an intravascular heat exchange catheter, and cardiopulmonary bypass. Intravenous lipid emulsion (ILE) was also administered. A discussion of cyclobenzaprine toxicity, hypothermia, ILE, and accidental hypothermic cardiac arrest follows.

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“…Although in one series of unintentional and intentional ingestions, no wide complex dysrhythmia occurred, a recent abstract showed a slightly widened QRS hours after ingestion [10,11].…”

Section: Introductionmentioning

confidence: 99%

Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

Bebarta

¹

,

Maddry

²

,

Borys

³

et al. 2012

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Background: The cyclobenzaprine structure is similar to amitriptyline; however, tricyclic antidepressant (TCA)-like wide complex dysrhythmia has not been reported. Our objective was to determine the incidence of TCA-like effects in cyclobenzaprine overdoses as reported to 6 poison centers for 2 years. We compared the incidence of these effects to amitriptyline overdoses collected during the same period. Methods: We performed a retrospective review of 2 years of cases as reported to the Texas Poison Center Network. We identified sole ingestions of cyclobenzaprine and of amitriptyline. Cases had a recorded clinical outcome and clinical effect. A trained reviewer used a standard data collection sheet within a secured electronic database. One investigator audited a random sample of charts. Results: We identified 3974 cases of cyclobenzaprine calls. Of these, we collected 209 cases of acute overdoses without coingestions. There were no deaths. No cases of cyclobenzaprine ingestions were reported to have died or have a wide QRS or ventricular dysrhythmia. Seizures were reported in 2 cases; however, both were unrelated to cyclobenzaprine. Hypotension was reported in 1.4% (3/209) of cases, and a vasopressor was used in one case (0.5%). Patients with an amitriptyline overdose were more likely to have seizure, coma, tachycardia, a wide QRS or ventricular dysrhythmia, and have received sodium bicarbonate or be intubated. Conclusions: Cyclobenzaprine overdoses were not reported to cause widened QRS, ventricular dysrhythmias, or seizures, and hypotension was rarely reported. Tricyclic antidepressant-related effects occurred more often in our comparison group of amitriptyline overdoses.

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Five-year multicenter retrospective review of cyclobenzaprine toxicity

Cited by 41 publications

References 10 publications

Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose

Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

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