ABSTRACT

Venlafaxine is a serotonergic and noradrenergic antidepressant. It shares serotonergic adverse effects with selective serotonin reuptake inhibitor (SSRI) antidepressants and causes noradrenergic adverse effects in particular cardiovascular disorders. However, it does not demonstrate advantages over SSRIs regarding efficacy. Most patients with a venlafaxine overdose develop only mild symptoms. Severe toxicity has been reported for venlafaxine, with the most common symptoms being central nervous system depression, serotonin toxicity, seizure or cardiac conduction abnormalities. We present a case of venlafaxine intoxication complicated by a late increase in creatine kinase (CK) level, seizures and cardiac toxicity. As reported in the literature, venlafaxine overdose can be fatal and can lead to cardiac toxicity and death. Patients may benefit from lipid emulsion-mediated therapeutic plasma exchange for the treatment of the lethal effects of venlafaxine intoxication. A 14-year-old patient with status epilepticus, long QTc interval and elevated CK level after venlafaxine overdose was successfully treated with lipid emulsion-mediated therapeutic plasma exchange.

Keywords: Venlafaxine intoxication, lipid emulsion treatment, status epilepticus, therapeutic plasma exchange, long QTc interval