Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report

Background: Psychotropic drugs can cause neurological effects when overdosed. This study reports a case of psychotropic drugs overdose presenting with serotonin toxicity and encephalopathy. Case presentation: A 20-year-old female with major depression presented with agitation 3 h after an overdose o...

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Autores principales:	Suthimon Thumtecho, Sorawit Wainipitapong, Suchai Suteparuk
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Escitalopram Bupropion Lurasidone Lamotrigine Serotonin syndrome Encephalopathy Toxicology. Poisons RA1190-1270
Acceso en línea:	https://doaj.org/article/8102e424350443c8887a528064c82b80
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spelling	oai:doaj.org-article:8102e424350443c8887a528064c82b802021-11-10T04:27:40ZEscitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report2214-750010.1016/j.toxrep.2021.11.003https://doaj.org/article/8102e424350443c8887a528064c82b802021-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214750021001876https://doaj.org/toc/2214-7500Background: Psychotropic drugs can cause neurological effects when overdosed. This study reports a case of psychotropic drugs overdose presenting with serotonin toxicity and encephalopathy. Case presentation: A 20-year-old female with major depression presented with agitation 3 h after an overdose on multiple medications. Her current medications were vortioxetine, lamotrigine, lurasidone, and bupropion (extended-release). Vital signs showed hyperthermia and tachycardia. Neurological examination was remarkable for mydriasis and hyperreflexia with inducible ankle clonus. The electrocardiography showed sinus tachycardia with QTc 480 ms. Twelve hours later, she became obtunded and developed subcortical myoclonus. The electroencephalogram demonstrated a diffuse encephalopathy pattern without epileptic activities. She was diagnosed with serotonin syndrome based on Hunter Serotonin Toxicity Criteria. Myoclonus and abnormal vital signs resolved within hours after cyproheptadine administration, but she remained unconscious for 3.5 days. Urine drug screening was positive for benzodiazepines and metabolites, lamotrigine, escitalopram, and hydroxybupropion. This suggested she had overdosed on escitalopram which had been previously prescribed. Unfortunately, vortioxetine and lurasidone could not be detected by our current facilities. Conclusion: This case exhibited serotonin syndrome and encephalopathy from overdose of multiple psychotropic agents. Her prolonged depressed consciousness could be explained by the half-life of the drugs and possible drug interactions.Suthimon ThumtechoSorawit WainipitapongSuchai SuteparukElsevierarticleEscitalopramBupropionLurasidoneLamotrigineSerotonin syndromeEncephalopathyToxicology. PoisonsRA1190-1270ENToxicology Reports, Vol 8, Iss , Pp 1846-1848 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Escitalopram Bupropion Lurasidone Lamotrigine Serotonin syndrome Encephalopathy Toxicology. Poisons RA1190-1270
spellingShingle	Escitalopram Bupropion Lurasidone Lamotrigine Serotonin syndrome Encephalopathy Toxicology. Poisons RA1190-1270 Suthimon Thumtecho Sorawit Wainipitapong Suchai Suteparuk Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report
description	Background: Psychotropic drugs can cause neurological effects when overdosed. This study reports a case of psychotropic drugs overdose presenting with serotonin toxicity and encephalopathy. Case presentation: A 20-year-old female with major depression presented with agitation 3 h after an overdose on multiple medications. Her current medications were vortioxetine, lamotrigine, lurasidone, and bupropion (extended-release). Vital signs showed hyperthermia and tachycardia. Neurological examination was remarkable for mydriasis and hyperreflexia with inducible ankle clonus. The electrocardiography showed sinus tachycardia with QTc 480 ms. Twelve hours later, she became obtunded and developed subcortical myoclonus. The electroencephalogram demonstrated a diffuse encephalopathy pattern without epileptic activities. She was diagnosed with serotonin syndrome based on Hunter Serotonin Toxicity Criteria. Myoclonus and abnormal vital signs resolved within hours after cyproheptadine administration, but she remained unconscious for 3.5 days. Urine drug screening was positive for benzodiazepines and metabolites, lamotrigine, escitalopram, and hydroxybupropion. This suggested she had overdosed on escitalopram which had been previously prescribed. Unfortunately, vortioxetine and lurasidone could not be detected by our current facilities. Conclusion: This case exhibited serotonin syndrome and encephalopathy from overdose of multiple psychotropic agents. Her prolonged depressed consciousness could be explained by the half-life of the drugs and possible drug interactions.
format	article
author	Suthimon Thumtecho Sorawit Wainipitapong Suchai Suteparuk
author_facet	Suthimon Thumtecho Sorawit Wainipitapong Suchai Suteparuk
author_sort	Suthimon Thumtecho
title	Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report
title_short	Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report
title_full	Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report
title_fullStr	Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report
title_full_unstemmed	Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report
title_sort	escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: a case report
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/8102e424350443c8887a528064c82b80
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Escitalopram, bupropion, lurasidone, lamotrigine and possible vortioxetine overdose presented with serotonin syndrome and diffuse encephalopathy: A case report

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