Although clinical trials of the antipsychotic amisulpride revealed no cardiac adverse effects, four patients with severe cardiac toxicity after overdose were reported to Australian poisons information centres in 2004–2005. All four had QT prolongation over 500 ms, two had rate-dependent bundle branch block, two developed torsades de pointes, and one died after cardiac arrest. Pending further studies, we recommend electrocardiogram assessment until at least 16 h after amisulpride overdose and, if QT interval is prolonged, cardiac monitoring until the patient is clinically well and conduction intervals are normal.
A 39-year-old woman presented to a rural hospital 2 hours after ingesting 24 g of amisulpride (therapeutic dose, 50–1200 mg/day), and unknown quantities of nitrazepam and diazepam. On examination, she was drowsy with a Glasgow Coma Score (GCS) of 14, heart rate of 100 beats per min (bpm), and systolic blood pressure of 70 mmHg. Activated charcoal (50 g) and intravenous normal saline (2 L) were administered, and the hypotension resolved. She was transferred to a tertiary emergency department.
- 1. Bohbot M, Doare L, Diquet B. Determination of a new benzamide, amisulpride, in human plasma by reversed-phase ion-pair high-performance liquid chromatography. J Chromatogr 1987; 416: 414-419.
- 2. Rosenzweig P, Canal M, Patat A, et al. A review of the pharmacokinetics, tolerability and pharmacodynamics of amisulpride in healthy volunteers. Hum Psychopharmacol 2002; 17: 1-13.
- 3. Coulouvrat C, Dondey-Nouvel L. Safety of amisulpride (Solian): a review of 11 clinical studies. Int Clin Psychopharmacol 1999; 14: 209-218.
- 4. Dorne R, Pommier C, Manchon M, Berny C. Intoxication with amisulpride (Solian): a case with toxicologic documentations. Therapie 2000; 55: 325-328.
- 5. Tracqui A, Mutter-Schmidt C, Kintz P, et al. Amisulpride poisoning: a report on two cases. Hum Exp Toxicol 1995; 14: 294-298.
- 6. Eleouet C, Lichtenstein D, Delhotal-Landes B, Flouvat B. Contribution of emergency toxicology in a case of amisulpride poisoning [abstract]. Eur J Emerg Med 2001; 8: 70.
- 7. Ward DI. Two cases of amisulpride overdose: a cause for prolonged QT syndrome. Emerg Med Australas 2005; 17: 274-276.
- 8. Musshoff F, Kroner L, Padosch SA, Madea B. Fatal intoxication with amisulpride and presentation of organ distribution. Arch Kriminol 2005; 215: 158-163.
- 9. Pehourcq F, Ouariki S, Begaud B. Rapid high-performance liquid chromatographic measurement of amisulpride in human plasma: application to manage acute intoxication. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 789: 101-105.
- 10. Rasmussen SL, Overo KF, Tanghoj P. Cardiac safety of citalopram: prospective trials and retrospective analyses. J Clin Psychopharmacol 1999; 19: 407-415.
- 11. Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol 2004; 42: 277-285.
- 12. Friberg LE, Isbister GK, Duffull SB. Pharmacokinetic pharmacodynamic modelling of QT interval prolongation following citalopram overdoses. Br J Clin Pharmacol 2006; 61: 177-190.
- 13. Tarabar AF, Hoffman RS, Nelson LS. Citalopram overdose: late presentation of torsades de pointes (TdP) with cardiac arrest [abstract]. J Toxicol Clin Toxicol 2003; 41: 676.
- 14. Meuleman C, Jourdain P, Bellorini M, et al. Citalopram and torsades de pointes. A case report. Arch Mal Coeur Vaiss 2001; 94: 1021-1024.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.