Abstract
The antidepressant milnacipran is a double serotonin/noradrenalin reuptake inhibitor. The low reported incidence of intoxication indicates excellent tolerance in comparison with tricyclic and second generation antidepressants. We report a fatal intoxication associating milnacipran, at blood levels (femoral=21.5 mg/l, cardiac=20 mg/l) 40-fold higher than the usual treatment concentration, and six other molecules (fluoxetine, norfluoxetine, sertraline, cyamemazine, nordazepam and oxazepam) at therapeutic levels. To the best of our knowledge, this is the first reported fatal intoxication involving milnacipran.
MeSH terms
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Adult
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Anti-Anxiety Agents / blood
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Antidepressive Agents / blood
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Antidepressive Agents / poisoning*
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Chromatography, High Pressure Liquid
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Cyclopropanes / blood
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Cyclopropanes / poisoning*
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Female
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Fluoxetine / analogs & derivatives
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Fluoxetine / blood
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Forensic Toxicology
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Gas Chromatography-Mass Spectrometry
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Humans
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Milnacipran
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Nordazepam / blood
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Oxazepam / blood
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Phenothiazines / blood
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Selective Serotonin Reuptake Inhibitors / blood
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Sertraline / blood
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Suicide
Substances
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Anti-Anxiety Agents
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Antidepressive Agents
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Cyclopropanes
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Phenothiazines
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Serotonin Uptake Inhibitors
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Fluoxetine
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Nordazepam
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Oxazepam
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cyamemazine
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Milnacipran
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norfluoxetine
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Sertraline