Reactions 393 - 21 Mar 1992

Fluvoxamine - safety in overdoseThe serotonin reuptake inhibitor, fluvoxamine,

appears to compare favourably with other newerantidepressants and evidence suggests that it is safe inoverdose.

The UK National Poisons Information Service (NPIS)has received 18 reports of fluvoxamine overdose (totaldose 0.3-3g); there were no fatalities or complications.Symptoms were minimal and included drowsiness,agitation, dizziness, vomiting, nausea, dilated pupils andabdominal pain. Three out of 10 patients who tookfluvoxamine alone were asymptomatic.

Most patients who had taken a combined overdosesuffered some additional adverse effects but these werealso minimal; however, 3 of these patients, including 2who had taken fluvoxamine and paracetamol, wereasymptomatic. Two patients took a combined overdoseof fluvoxamine with temazepam +/- alcohol; 1 lostconsciousness and experienced sinus bradycardia andthe other suffered respiratory depression, drowsiness,blurred vision, hypotension and abdominal pain.Patients were treated with emesis, gastric lavage oractivated charcoal, and all recovered uneventfully.

National mortality records for England, Wales andScotland for the years 1984-89 were also examined.One death was reported due to acute poisoning withfluvoxamine. There were no reports of death caused byfluvoxamine in combination with other drugs.

The manufacturers of fluvoxamine are aware of310 cases of overdose in which fluvoxamine was one ofthe drugs ingested. In general, the patients experiencedminimal adverse effects with drowsiness being the mostcommon (figure available in print version; see Reactions393: 5, 21 Mar 1992). Sinus bradycardia occurred in 15patients, tachycardia in 37 and there were 22 reports ofother ECG abnormalities. All of these cases were mildand did not require treatment. There were 64 cases ofcoma; the patients had ingested fluvoxamine doses of >1.5g. Symptoms of overdose resolved within 24-36hours in most cases. Gastric lavage and symptomatictreatment resulted in complete recovery in mostpatients. 13 patients died; all had taken a multiple drugoverdose.

’When its toxicity profile is considered in conjunctionwith its ability to produce an early reduction in suicidalideation, it is apparent that fluvoxamine has significantadvantages over many currently used antidepressants.’Henry JA. Overdose and safety with fluvoxamine. International ClinicalPsychopharmacology 6 (Suppl. 3): 41-47, Dec 1991 800123521

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Reactions 21 Mar 1992 No. 3930114-9954/10/0393-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved