Effectiveness of intravenous lipid emulsion in reducing the toxicity of lipophilic drug overdose

Abstract

Cardiovascular collapse caused by overdose of drugs including tricyclic antidepressant has been conventionally treated by fluid and vasopressors. Intravenous lipid emulsion (ILE) is reported as a rescue therapy for the toxicity of lipophilic drug overdose, of which the logP (octanol: water partition coefficient) is > 2. We report the case of a 49-year-old woman transferred to our critical care center following an overdose of multiple psychotropic drugs. Drugs (logP [measured/theoretical value]) she took included amoxapine [ND/2.6] 450 mg, amitriptyline [1.9/5.0] 90 mg, and trazodone [3.85/2.8] 600 mg. Her BP suddenly dropped to 57/33 mmHg 5 hours after overdosing and her BP didn’t rise by intravenous fluid infusion and administration of dopamine. After ILE was administered, her BP returned to 84/41 mmHg. This case suggests that ILE can reduce the toxicity of lipophilic drug overdose. Therefore, ILE should be considered when resuscitating patients with cardiovascular collapse caused by lipophilic drug toxicity.