Is 1350mg of sertraline (selective serotonin reuptake inhibitor) toxic to an individual weighing 8 stone (approximately 51 kg)?

Sertraline Overdose of 1350mg is Potentially Life-Threatening for a Person Weighing 8 Stone (51kg)

A 1350mg dose of sertraline is potentially toxic and life-threatening for an individual weighing 8 stone (51kg) and requires immediate medical attention. 1

Toxicity Assessment

• The dose of 1350mg represents approximately 26.5mg/kg for a person weighing 51kg, which significantly exceeds the therapeutic range 1
• According to FDA data, fatal outcomes have been reported with sertraline ingestions as low as 2.5 grams (2500mg), while others have survived larger doses of 13.5 grams 1
• The toxicity risk is particularly concerning for someone with lower body weight, as drug distribution and metabolism are affected by body mass 2

Clinical Manifestations of Sertraline Toxicity

Sertraline overdose can cause a spectrum of symptoms ranging from mild to severe:

Common Symptoms

• Somnolence, vomiting, tachycardia, nausea, dizziness, agitation, and tremor 1
• Confusion, agitation, myoclonus (muscle jerking), hyperreflexia 3

Severe Complications

• Serotonin syndrome - a potentially life-threatening condition characterized by:
  • Mental status changes (confusion, agitation, hallucinations) 1, 4
  • Neuromuscular abnormalities (rigidity, tremor, myoclonus, hyperreflexia) 4
  • Autonomic instability (hyperthermia, tachycardia, blood pressure fluctuations, diaphoresis) 4
• QT-interval prolongation and cardiac arrhythmias including Torsade de Pointes 1
• Rhabdomyolysis (breakdown of muscle tissue) requiring intensive care 4
• Seizures, coma, and potentially death 1

Management Protocol

Immediate Actions

• Seek emergency medical care immediately - this is not a situation for home management 1, 4
• Do not induce vomiting as this is not recommended for sertraline overdose 1

Hospital Management

• Airway management with oxygenation and ventilation as needed 1
• Cardiac monitoring for rhythm disturbances 1
• Gastric lavage may be considered if performed soon after ingestion 1
• Activated charcoal administration to reduce absorption 1
• Supportive care including IV fluids 4
• Benzodiazepines for agitation, seizures, or muscle rigidity 4
• In severe cases of serotonin syndrome, cyproheptadine (a serotonin antagonist) may be administered 4
• Intensive care monitoring may be required for severe cases 4

Risk Factors and Considerations

• Lower body weight (51kg) increases risk of toxicity due to higher drug concentration per kg of body weight 2
• Pre-existing medical conditions or concurrent medications may increase toxicity risk 1
• While some mild overdoses may be asymptomatic, a dose of 1350mg is substantial enough to warrant serious concern 5
• The elimination half-life of sertraline ranges from 22-36 hours, meaning toxic effects may persist for an extended period 2

Important Caveats

• Even though sertraline is considered safer in overdose than tricyclic antidepressants, it can still cause significant toxicity at high doses 2
• Children and adolescents have been reported to develop severe symptoms requiring intensive care after sertraline overdose 4
• The clinical presentation can evolve over time, with some symptoms appearing hours after ingestion 4
• Multiple drug involvement should always be considered as it can significantly worsen outcomes 1