SSRI (selective serotonin reuptake inhibitor) 血清素再吸收阻斷劑
SUBSTANCE
-
Newer and safer antidepressant
compared to TCA [1].
-
Lower ADR than TCA.
Common
name or Trade name
-
Fluvoxamine、Paroxetine、Sertraline、Citalopram、Escitalopram、Fluoxetine。
Involving
SYSTEM
-
Serotonin, about 98% in extra-CNS [2]。
-
A long elimination half-life,
with sustained biological activity due to active metabolites
-
In overdose, SSRI elimination
times are further prolonged by the saturation of metabolic enzymes and by
delayed absorption, especially for sustained-release preparations.
-
Electrolyte imbalance:
hyponatremia, easily seen in the elderly [3].
-
Neural system: extra-pyramidal,
hyperreflexia, Clonus, myoclonus [4].
-
Respiratory
system: failure. Cough.
-
Gastrointestinal
system: nausea, upset.
Presentation
-
Cause vomiting, mild CNS
depression, or tremor.
-
Hyponatremia.
-
Unstable blood pressure. Arrhythmia.
VT. Arrest, QRS QTc prolongation, Torsades de pointes [5].
-Bradycardia, hypotension: Fluvoxamine (Luvox)
- hyperreflexia, Clonus, myoclonus.
- Sweating, agitation.
- fever, coma, seizure (1.9%) [6].
Antidote
and Treatment
-
BLS, gastric lavage < 1 hr.
-
Activated charcoal.
-
Not recommended for laxative.
-ACLS, inotropic agent.
-Nitroglycerin或Nitroprusside for
hypertension。
- magnesium
sulfate 2 g IV over 2 min for Torsades de points
-
wide QRS: NaHCO3 1 to 2 mEq/kg IV push
- (benzodiazepine, BZD) for seizure.
- Serotonin antagonist:
-Cyproheptadine (oral form; sedation) [7].
- (Extrapyramidal signs): Diphenylhydramine
50mg bid。
Disposition
-
Suspicious: observe 6-8 hours
with ECG monitoring, if no symptoms, then may be discharged.
-
Citalopram, need observe longer
to 12hours, observe arrhythmia / convulsion [8].
REFERENCES
[1]. https://pubmed.ncbi.nlm.nih.gov/35206480/
[2]. https://pubmed.ncbi.nlm.nih.gov/19361459/
[3]. https://pubmed.ncbi.nlm.nih.gov/34483534/
[4]. https://pubmed.ncbi.nlm.nih.gov/23391344/
[5]. https://pubmed.ncbi.nlm.nih.gov/31845095/
[6]. https://pubmed.ncbi.nlm.nih.gov/30521236/
[7]. https://pubmed.ncbi.nlm.nih.gov/20833944/
[8]. https://pubmed.ncbi.nlm.nih.gov/33489987/
Edited by Yu-Jang Su May 26, 2022
