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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Amoxapine is a second-generation antidepressant that has been reported to cause seizures, severe acidosis, cardiac dysrhythmias, hypotension, renal failure, coma, and cardiorespiratory arrest in poisoning exposures. This is a report of a previously normal 9-year-old child who presented with generalized tonic clonic seizures that led to an extensive workup for primary generalized epilepsy. Nothing in the patient's history or laboratory test results suggested ingestion of a toxin. It was not until 48 hours after admission, when the child admitted taking several of her mother's amoxapine tablets, that the correct diagnosis was made. Because of the risks and the diagnostic pitfalls associated with ingestion of amoxapine, clinicians should be mindful of the lessons taught by this case.
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PMID:Diagnostic pitfalls associated with amoxapine overdose: a case report. 236 58

Postmarketing adverse drug reaction reports for amoxapine, maprotiline hydrochloride, and trazodone hydrochloride and premarketing adverse drug reaction data for bupropion hydrochloride and nomifensine maleate are reviewed, and the role of the new agents in the management of depressive illness is discussed. Nomifensine was withdrawn from markets worldwide because of reports of serious hypersensitivity reactions, especially hemolytic anemia, and marketing of bupropion in the United States was delayed after seizures occurred in bulimic patients in clinical trials. Amoxapine and maprotiline, when taken in overdose attempts, are more toxic and cause more serious central nervous system reactions than the standard tricyclics. Acute renal failure and an increased mortality rate are associated with amoxapine overdose. Amoxapine causes several acute and chronic untoward neurologic and endocrine reactions not commonly associated with the standard tricyclics. For maprotiline and bupropion, maximum doses have been established because of dose-related seizures. Trazodone has minimal effect on cardiac conduction; its main cardiovascular effects are hypotension, orthostasis, and dizziness. The trazodone package insert has been revised to warn of priapism; patients with prolonged or inappropriate penile erections are instructed to discontinue the drug and notify the physician. Serious cardiovascular and neurologic toxicities are rare with trazodone overdose. Of the newly marketed antidepressants, only trazodone offers some advantages over the tricyclic and tetracyclic agents in the areas of side effects and toxicities. The number and type of patients exposed to a new drug during clinical trials is too small for detection of rare but potentially serious adverse effects.
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PMID:Adverse reactions to five new antidepressants. 308 84

The authors review four "second generation" antidepressants (maprotiline, amoxapine, trazodone, and nomifensine) in terms of action on biogenic amines and receptors, antidepressive efficacy, and adverse effects. Doxepin is used as a comparative agent and is similar to the prototypical tricyclic agents in all the above categories. Maprotiline is a selective noradrenergic agent, but shares a similar adverse effect profile with doxepin and may be associated with a high frequency of seizures in overdose. Amoxapine is a mixed action antidepressant with significant neuroleptic activity in vivo. Its adverse effect profile is highlighted by symptoms related to its neuroleptic activity, and seizures and acute renal failure in overdose. Trazodone is a selective serotonergic agent with low anticholinergic activity, and minimal morbidity/mortality in overdose. Reports of priapism, leading to impotence in some men, however, is of concern. Nomifensine is a potent noradrenergic and dopaminergic agent with low anticholinergic activity, and minimum cardiotoxicity and low morbidity/mortality in overdose. Its most important adverse effects include overstimulation and infrequent, usually reversible, immunologic hypersensitivity reactions. Trazodone and nomifensine have favorable profiles for use in the elderly. Trazodone may be more favorable in the anxious/agitated patient due to its sedative effects, whereas nomifensine may be more beneficial in the retarded, apathetic patient.
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PMID:Second generation antidepressants: a comparative review. 389 97

Two infants presented for medical evaluation with sudden onset of seizures or coma, without obvious cause. Suspicious circumstances led to toxicological screening analysis. Amoxapine, a recently released antidepressant, was found in the gastric contents of both children an undetermined time after the putative ingestion, but elevated serum concentrations were noted only in one. The pharmacokinetics are described. There were no obvious cardiotoxic or anticholinergic effects in these infants. Thus, they, like older children and adults, manifest mainly central nervous system toxicity rather than the cardiotoxicity and anticholinergic effects of overdose seen with tricyclic antidepressants.
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PMID:Generalized convulsions as the presenting sign of amoxapine intoxication. 669 33

Amoxapine, a tricyclic antidepressant, is metabolized to 8-hydroxyamoxapine and 7-hydroxyamoxapine. There are few reports on the metabolism of this drug and correlation of clinical symptoms in overdose patients. Five such patients admitted to the Emergency Unit of the University of Cincinnati Hospital were studied. Clinically, all had seizures and evidence of altered cardiac function. The amounts of the parent drug and the 7- and 8-hydroxy metabolites were measured and, in all cases, the parent and 8-hydroxy metabolite were present in both urine and serum. In contrast, the 7-hydroxyamoxapine was found in trace amounts in the serum of only two patients, but in the urine of all the patients observed. These observations were confirmed by gas chromatographic/mass spectroscopic analysis. The pattern of metabolism was analogous to that found in patients on maintenance doses of the drug. In two overdose patients, it was possible to monitor the levels as a function of time. The elimination curve of parent and metabolite was first order with a half-life of 8.5 to 15.0 and 48 hr, respectively.
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PMID:Amoxapine in human overdose. 673

Thirty-three amoxapine overdoses, including five fatalities, were reported to two regional poison centers over an 18-month study period. The 15.2% mortality rate stands in alarming contrast to the 0.7% death rate for all other cyclic antidepressant overdoses reported to these same two centers during the study. Seizure activity was noted in 36.4% of amoxapine overdoses, compared with 4.3% of other cyclic antidepressant poisonings. Amoxapine appears to be responsible for a disproportionate share of seizures and deaths resulting from cyclic antidepressant overdose.
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PMID:Amoxapine overdose. Seizures and fatalities. 687 45

Amoxapine is a second-generation tricyclic antidepressant structurally related to the neuroleptic loxapine. It was previously marketed as an alternative to traditional tricyclic antidepressants because of alleged shorter onset of action and fewer cardiotoxic effects. However, various adverse reactions, including cardiac dysrhythmias, renal failure, coma, seizures, and neuroleptic malignant syndrome, were reported during therapy or after acute overdose. A 14-year-old boy ingested 1900 mg of amoxapine and developed seizures, hypertension, hyperpyrexia, altered mental status, myoglobinuria, renal failure, and transient magnetic resonance imaging (MRI) changes suggestive of hypertensive encephalopathy and neuroleptic malignant syndrome. Since mitochondrial disorders can cause multisystem failure, including encephalopathy, renal tubular dysfunction, and myopathy, a transient, toxic disorder of mitochondrial function was considered as the basis for the patient's clinical and MRI changes.
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PMID:Amoxapine overdose in a young man: a transient mitochondrial abnormality? 747 9

Amoxapine, a tricyclic antidepressant, is widely used by psychiatrists. While overdose of tricyclic antidepressants is known to be dangerous and potentially fatal (causing hypotension, arrhythmia, convulsions, respiratory failure, and other serious complications), overdose of amoxapine can cause other problems, and metabolic acidosis, seizures, neuroleptic malignant syndrome, and arrhythmia have been reported. This report describes the case of a patient who developed rhabdomyolysis and acute renal failure following amoxapine overdose. Continuous hemofiltration was instituted twice, and he recovered without sequelae; this suggests the effectiveness of continuous hemofiltration and its possibilities in the treatment of amoxapine overdose and acute renal failure due to rhabdomyolysis.
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PMID:Successful treatment of rhabdomyolysis and acute renal failure following amoxapine overdose. 2492 98