Sertraline drug overdose

Highly suicidal patients should be given agents posing less risk of lethality with overdose and less risk of interacting with other drugs taken in an overdose attempt (i.e., sertraline, citalopram, or venlafaxine). 

A few deaths have occurred during overdosage of SSRIs when other drugs were also being taken. The likelihood of fatalities from SSRI overdoses is extremely low. In case of overdose, only supportive treatment can be offered, since the high volume of distribution, as with other antidepressants, rules out removal of drug by dialysis. As much as 2.6 g of sertraline has been taken with survival. Overdoses of paroxetine are relatively benign Up to 850 mg has been taken with no evidence of cardiotoxicity. 

Fluoxetine is a potential drug of abuse.136 Overdose with sertraline causes suicidal tendencies, whereas citalopram causes fatal reactions such as cardiac dysfunction.137 The adverse effects could be treated with stomach wash, administration of activated charcoal, dialysis, and hemoperfusion. 

A meta-analysis of 20 short-term studies of five SSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) has been published (8). There were no overall differences in efficacy, but fluoxetine had a slower onset of action. Citalopram and sertraline were least likely to cause drug interactions, but citalopram was implicated more often in fatal overdoses. 

Rarely lethal in monotherapy overdose vomiting, sedation, heart rhythm disturbances, dilated pupils, agitation fatalities have been reported in sertraline overdose combined with other drugs or alcohol... 

Sertraline has the potential to cause serotonin syndrome . Most commonly, this syndrome occurs when two or more drugs capable of enhancing serotonin activity are used concomitantly. This syndrome can occur in the overdose situation. 

The selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment of depression in the elderly. Compared with tricyciic antidepressants (TCAs), they are much safer in overdose and, for the most part, their side-effects are better tolerated. The antidepressants that have been shown, in controlled studies, to be effective in geriatric major depression are the SSRIs fluoxetine, paroxetine, and sertraline, the TCAs clomipramine and nortriptyline, and the serotonin and norepinephrine reuptake inhibitor (SNRi) venlafaxine. Given that most antidepressants are effective in the elderly, the choice of drug is based on its side-effect profile and its potential to interact with other medications. 

Clomipramine, a tricyclic, is a more selective inhibitor of serotonin reuptake than other drugs in its class. This activity appears to be important in the treatment of obsessive-compulsive disorder (OCD). Patients with OCD are also responsive to sertraline and other selective serotonin reuptake inhibitors, and the SSRIs have now become the drugs of choice for this disorder since they are safer in overdose than tricyclics. The answer is (C). 

A fatality has been reported with an overdose of moclobemide, sertraline and pimozide, with blood levels suggesting that none of the drugs individually would have been fatal. "... 

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