Treatment of Sertraline Overdose
The treatment of sertraline overdose consists of general supportive measures including airway management, cardiac monitoring, and activated charcoal administration if presented early, as there is no specific antidote for sertraline toxicity. 1
Initial Management
- Ensure adequate airway, oxygenation, and ventilation as the first priority in management 1
- Monitor cardiac rhythm and vital signs continuously, as sertraline overdose can cause tachycardia, bradycardia, QT-interval prolongation, and Torsade de Pointes 1
- Gastric lavage with a large-bore orogastric tube may be indicated if performed soon after ingestion or in symptomatic patients, with appropriate airway protection 1
- Administer activated charcoal to reduce absorption, especially if the patient presents within a few hours of ingestion 1
Clinical Manifestations to Monitor
- Neurological symptoms: somnolence, agitation, confusion, tremor, myoclonus, hyperreflexia, and potential seizures 1, 2
- Cardiovascular effects: tachycardia, bradycardia, hypertension, hypotension, QT prolongation 1
- Gastrointestinal symptoms: nausea, vomiting, diarrhea 1
- Signs of serotonin syndrome: mental status changes, neuromuscular hyperactivity, autonomic hyperactivity, fever 3, 2
Serotonin Syndrome Management
- Discontinue all serotonergic agents immediately 3
- Provide hospital-based supportive care with continuous cardiac monitoring 3
- Monitor for advanced symptoms including fever, seizures, arrhythmias, and unconsciousness which can lead to fatalities 3
- Be vigilant for serotonin syndrome particularly when sertraline is combined with other serotonergic medications 3
Specific Interventions
- Forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be beneficial due to sertraline's large volume of distribution 1
- Consider contacting a poison control center for guidance on treatment of the overdose 1
- For patients with significant symptoms, admission for observation and supportive care is recommended 4
Prognosis and Monitoring
- Most sertraline-only overdoses result in mild symptoms or no symptoms at all, with serious toxicity being uncommon 4
- Monitor patients for at least 24 hours, with consideration for longer observation (up to 72 hours) in children and adolescents, as psychiatric symptoms may evolve over time 5
- The majority of patients recover completely, though some may experience sequelae including fatigue, insomnia, somnolence, and serotonin syndrome 1
Special Considerations
- Consider the possibility of multiple drug involvement in any overdose case, as this can significantly alter the clinical presentation and management 1
- Be aware that sertraline has a more favorable safety profile in overdose compared to tricyclic antidepressants, but deaths have been reported with very large ingestions 3, 1
- In cases of massive overdose, intensive supportive care is crucial as fatalities have been reported 1, 2
Pitfalls and Caveats
- Do not induce emesis as this is not recommended in the management of sertraline overdose 1
- Avoid administering other serotonergic agents which could worsen serotonin syndrome 3
- Be aware that symptoms may be delayed, particularly psychiatric manifestations, requiring extended observation in some cases 5
- Remember that while most sertraline overdoses have favorable outcomes, fatal cases have been reported, particularly with very large ingestions 1