Amaducci, Alexandra, DO

Cannon, Robert D., DO

Fikse, Derek J, DO

Katz, Kenneth D, MD

Vido, Margaret A, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Emergency Medicine Duloxetine Poisoning: A Unique Case of Cardiotoxicity Derek J. Fikse DO Lehigh Valley Health Network, Derek.Fikse@lvhn.org Alexandra Amaducci DO Lehigh Valley Health Network, Alexandra.Amaducci@lvhn.org Margaret A. Vido DO Lehigh Valley Health Network, margaret.vido@lvhn.org Robert D. Cannon DO Lehigh Valley Health Network, Robert_D.Cannon@lvhn.org Kenneth D. Katz MD Lehigh Valley Health Network, Kenneth_D.Katz@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/emergency-medicine  Part of the Medical Toxicology Commons Published In/Presented At Fikse, D., Amaducci, A., Vido, M., Cannon, R., & Katz, K. (2021, April). Duloxetine Poisoning: A Unique Case of Cardiotoxicity. [Poster presentation]. Pennsylvania College of Emergency Physicians, PACEP SA21 Spivey and CPC Competitions, Virtual. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2021 Lehigh Valley Health NetworkSOCH3NHDuloxetine Poisoning: A Unique Case of Cardiotoxicity  Derek J. Fikse, DO; Alexandra M. Amaducci, DO; Margaret A. Vido, DO; Robert D. Cannon, DO; Kenneth D. Katz, MDLehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pa.BackgroundDuloxetine is a SNRI similar to venlafaxine. While cardiotoxicity from venlafaxine poisoning has been described, it has not previously been reported with duloxetine. CaseA 15-year-old boy with PMH of depression and anxiety prescribed fluoxetine 20 mg and hydroxyzine 10 mg intentionally ingested 3,060 mg of his mother’s duloxetine pills. Notable VS were BP 145/88 and HR 127. On exam, his mental status was normal. He was noted to have six beat ankle clonus and hyperreflexia.  CBC, CMP, VBG, salicylate, acetaminophen, and ethanol were unremarkable. Initial EKG demonstrated sinus tachycardia 109 bpm, QRS 103 ms, and QTc 462 ms. One hundred ml of 8.4% sodium bicarbonate was administered intravenously without any change in the QRS duration. Serial EKGs demonstrated gradual prolongation of QRS and QTc reaching a maximum of 134 ms and 543 ms, respectively. Sodium bicarbonate IV was re-administered, again without improvement in the QRS duration. Although his tachycardia and serotonergic signs resolved within 12 hours post ingestion, the QRS widening persisted with gradual resolution over 84 hours to 100 ms. He developed neither hemodynamic instability nor dysrhythmias. Serum LC/MS detected duloxetine, fluoxetine, hydroxyzine, cannabinoids, and caffeine. The patient was  admitted to inpatient psychiatry on hospital day five. DiscussionThe patient was prescribed fluoxetine, a potent CYP450 2D6 inhibitor, which may have inhibited the metabolism of duloxetine, also metabolized by CYP450 2D6. Although in vitro evidence exists demonstrating duloxetine’s ability to block cardiac sodium channels, QRS widening or other clinically significant cardiotoxicity has not been described. It is also noteworthy that this patient’s QRS interval did not improve after sodium bicarbonate administration. Neither fluoxetine nor hydroxyzine is expected to cause QRS widening. ConclusionPhysicians should be aware of the potential for duloxetine-induced cardiotoxicity.

Duloxetine Poisoning: A Unique Case of Cardiotoxicity

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1657&context=emergency-medicine

Duloxetine Poisoning: A Unique Case of Cardiotoxicity

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