Referral to hospital is only required in a larger ingestion of if they become symptomatic. Children: Ingestion of up to 3 tablets is benign.Minor symptoms are usually present within 4 hours and have resolved within 12 hours. Co-ingestion with other serotonergic agents greatly increases the risk of serotonin toxicity. Serotonin toxicity: Usually mild symptoms and only in 20% of patients, usually lasts Seizures: Occur in 600 mg of citalopram and >300 mg of escitalopram.Can be managed with benzodiazepines (varying doses in the textbooks, easy method is 0.1mg/kg IV for lorazepam (max 4mg) / midazolam (max 10mg) / diazepam (max 10mg).Check the patient is not in a dysrhythmia.Seizures: IV benzodiazepines incrementally dosed every 5 minutes to effect.Elimination half life is approximately 24 hours.Hepatic metabolism to water soluble and less active metabolites.Large Volume of distribution 12 – 97L/kg.Simple mechanism, they solely enhance the central serotonergic neurotransmission by inhibiting serotonin reuptake. Citalopram (>600 mg) and escitalopram (>300 mg) are unique in their ability to cause dose dependent QT prolongation and a risk of torsades de points. Serotonin toxicity occurs in a minority but is more common with co-ingestant agents with serotonergic action. SSRIs or Selective serotonin reuptake inhibitors are common in overdose and usually follow a benign course.
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