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Amisulpride deliberate self-poisoning causing severe cardiac toxicity including QT prolongation and torsades de pointes

Geoffrey K Isbister, Lindsay Murray, Sally John, L Peter Hackett, Tedo Haider, Phebe O'Mullane, Sophie Gosselin and Frank Daly
Med J Aust 2006; 184 (7): 354-356.

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.

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  • Geoffrey K Isbister1,2,3
  • Lindsay Murray3,4
  • Sally John5
  • L Peter Hackett6
  • Tedo Haider7
  • Phebe O'Mullane8
  • Sophie Gosselin9,10
  • Frank Daly11,3,12

  • 1 Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, NT.
  • 2 Newcastle Mater Hospital, Waratah, NSW.
  • 3 NSW Poisons Information Centre, The Children's Hospital at Westmead, Westmead, NSW.
  • 4 University of Western Australia, Perth, WA.
  • 5 Port Macquarie Hospital, Port Macquarie, NSW.
  • 6 Clinical Pharmacology and Toxicology, PathWest Laboratory Medicine, Perth, WA.
  • 7 Tumut District Hospital, Tumut, NSW.
  • 8 Gosford Hospital, Gosford, NSW.
  • 9 McGill University Health Centre, Montreal, Canada.
  • 10 Quebec Poison Control Centre, Montreal, Canada.
  • 11 Royal Perth Hospital, Perth, WA.
  • 12 Clinical Toxicology, WA Poisons Information Centre, Perth, WA.

Correspondence: gsbite@ferntree.com

Competing interests:

None identified.

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