SSRIs, SNRIs and other new generation antidepressants | Tricyclic antidepressants | Antipsychotics | Lithium | |
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Severe poisoning caused by an SSRI or other new generation antidepressant alone is rare. | Poisoning is rare but exceptionally severe. | Tolerance may be low if the patient is unaccustomed to antipsychotics. | People who have not previously used lithium may tolerate even high doses, and people using lithium may show symptoms of poisoning at even only slight overdose | |
Active ingredients belonging to the group | Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram Venlafaxine, mirtazapine, reboxetine | Nortriptyline, amitriptyline, clomipramine, trimipramine, doxepin | Chlorpromazine, levomepromazine, promazine, chlorprothixene, thioridazine, haloperidol, perphenazine Olanzapine, risperidone, quetiapine, clozapine | Lithium |
Mechanism of action | Inhibition of reuptake of serotonin (in some cases noradrenaline or dopamine) | Inhibition of reuptake of serotonin, noradrenaline and dopamine in nerve cells + sodium channel blockade | Dopamine receptor blockade, in some cases also effects such as serotonin, muscarine or histamine receptor blockade | Exact mechanism of action not known |
Clinical picture |
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Treatment |
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* Sodium bicarbonate (NaHCO3) |
Tricyclic antidepressants
SSRIs
Drug group | Features associated with poisoning | Treatment |
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Paracetamol |
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Aspirin Other NSAIDs |
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Antiepileptic drugs Phenytoin, carbamazepine, valproic acid, lamotrigine, lacosamide, topiramate, levetiracetam, pregabalin, gabapentin |
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Methotrexate |
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Iron |
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Oral antidiabetics |
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Insulin |
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* Sodium bicarbonate (NaHCO3) |
Aspirin (Acetylsalicylic acid)
Other non-steroidal anti-inflammatory drugs
Pregabalin
Drug group | Features associated with poisoning |
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ACE inhibitors and ARBs |
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Diuretics |
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Nitrates |
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Beta-blockers and calcium-channel blockers |
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Other antiarrhythmic drugs |
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Digoxin and other cardiac glycosides (e.g. foxglove/digitalis products) |
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Chloroquine, hydroxychloroquine |
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N.B! |
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Beta-blockers
Calcium channel blockers
Digoxin