US EPA

4093078 

Journal Article 

Escitalopram Overdose: A Case Series 

Seifert, SA; Meissner, GK 

2004 

1 

Journal of Toxicology: Clinical Toxicology
ISSN: 0731-3810
EISSN: 1097-9875 

TOX/5000019 

42 

4 

English 

Objective: To describe a case series of escitalopram (Lexapro?) overdoses. Methods: Regional Poison Center retrospective case series. Results: Between 9/02 and 3/03, 18 escitalopram exposures were reported. Five involved escitalopram alone and 13 as a co-ingestant. In the isolated exposures, the approximate mean escitalopram dose was 58 mg (1 mg/kg) with a range of 10 to 170 mg (0.4?2.9 mg/kg), with a mean age of 26.2 years (range 5?44 years). Three of the five cases were therapeutic errors, one an unintentional exposure and one an intentional overdose. All were managed at home, with the intentional ingestion refusing a health care facility evaluation. Treatments included observation in all and GI dilution in one. One patient became symptomatic (30 mg therapeutic error), with complaints of burning sensation of the skin on the upper half of the body, headache, shakiness, and anxiety. Four cases remained asymptomatic. Average TESS Outcome Score in the five isolated exposure cases was 1.2 (range 1?2, with 1=no effects; 2=minor effects; 3=moderate effects; 4=major effects; 5=death). The approximate dose of escitalopram was known in 9 of the 13 cases in which it was a co-ingestant. The mean dose of escitalopram in those cases was 126 mg (1.8 mg/kg) with a range of 5?600 mg (0.1?8.6 mg/kg). CNS depression occurred in seven of 13 (54%) cases, cardiovascular effects in seven (54%), and ECG changes in three (23%). In all cases, other agents also capable of causing those effects were involved in the exposure. Discussion: Escitalopram is a selective serotonin reuptake inhibitor (SSRI) and is the S(+)-enantiomer of citalopram. It was approved by the US FDA in January, 2002. Overdose experience with escitalopram is very limited. A case series of 14 isolated escitalopram ingestions greater than 100 mg (range 100?600 mg) demonstrated no effect in 50% and a minor effect in 50% (1). In this case series, isolated exposures to escitalopram at or below 2.9 mg/kg produced no to minimal effects. Conclusion: At doses at or below 2.9 mg/kg, isolated exposures to escitalopram produced no to minimal effects. In higher doses or in poly-substance ingestions, escitalopram may contribute to CNS depression, cardiovascular or ECG effects.