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Phenelzine Overdose Treated With Dantrolene Sodium FREE

Richard F. Kaplan, MD; Neil G. Feinglass, MD; Will Webster, PharmD; Stephen Mudra, MD
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JAMA. 1986;255(5):642-644. doi:10.1001/jama.1986.03370050084027
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THE INGESTION of a monoamine oxidase (MAO) inhibitor can induce a complex array of hypermetabolic signs, including hyperpyrexia, tachycardia, generalized muscle rigidity, tachypnea, metabolic acidosis, hypoxemia, and hypercapnia1 (J. W. Katalavis, MD, oral communication, November 1984). Toxicity of MAO inhibitors has previously been treated with standard therapy, ie, gastric lavage with activated charcoal, magnesium citrate, alkalinization of urine, and general support. Similar fulminant hypermetabolic states, such as neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH), respond to dantrolene sodium. Although two brief reports have been published,2,3 there has been no well-documented report of a fulminant hypermetabolic reaction to a MAO inhibitor that was treated with dantrolene sodium. We report a severe case of phenelzine (Nardil) overdose; the patient failed to respond to conventional therapy but dramatically improved with the administration of dantrolene sodium.

Report of a Case  A 33-year-old, 70-kg, well-developed man with a history of hypertension and

REFERENCES

Bowen LW:  Fatal hyperpyrexia with antidepressant drugs . Br Med J 1964;;2:1465-1466.
Ritchie P:  Neuroleptic malignant syndrome, correspondence . Br Med J 1983;;287:561.
Mirchandani H, Reich LE:  Fatal malignant hyperthermia as a result of ingestion of tranylcypromine (Parnate) combined with white wine and cheese . J Forensic Sci 1985;;30:217-220.
Cooper TB, Robinson DS, Nies A:  Phenelzine measurement in human plasma: A sensitive GLC-ECD procedure . Communications Psychopharmacol 1978;;2:505-512.
Rosenberg H, Reed S:  In vitro contracture tests for susceptibility to malignant hyperthermia . Anesth Analg 1983;;62:415-420.
Goodman L, Gilman A: The Pharmacologic Basis of Therapeutics , ed 6. New York, Macmillan Publishing Co Inc, 1980;, pp 427-430.
Caroff SN:  The neuroleptic malignant syndrome . J Clin Psychiatry 1980;;41:79-83.
Henderson VW, Wooten GF:  Neuroleptic malignant syndrome: A pathogenic role for dopamine receptor blockade? Neurology 1981;; 31:132-137.
Caroff S, Rosenberg H, Gerber JC:  Neuroleptic malignant syndrome and malignant hyperthermia . Lancet 1983;;1:244.
Britt BA, Kalow W:  Malignant hyperthermia: A statistical review . Can Anaesth Soc J 1970;;17:293-315.
Nelson TE, Flewellen EH:  The malignant hyperthermia syndrome . N Engl J Med 1983;; 309:416-418.
Gronert GA:  Malignant hyperthermia . Anesthesiology 1980;;53:395-423.
Ryan JF:  Malignant hyperpyrexia: Diagnosis and treatment , in: 31st Annual Refresher Course Lectures . Park Ridge, Ill, American Society of Anesthesiologists, 1980;, lecture 237, pp 1-3.
Kolb ME, Horne ML, Martz R:  Dantrolene in human malignant hyperthermia: A multicenter study . Anesthesiology 1982;;56:254-262.
Coons DJ, Hillman FJ, Marshall RW:  Treatment of neuroleptic malignant syndrome with dantrolene sodium: A case report . Am J Psychiatry 1982;;139:944-945.
Smithson WA, Gronert GA, Moss KK:  Dantrolene and potentially fatal hyperthermia secondary to L-asparaginase . Cancer Treat Rep 1983;;67:318-319.
Lydiatt JS, Hill GE:  Treatment of heat stroke with dantrolene . JAMA 1981;;246:41-42.

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Bowen LW:  Fatal hyperpyrexia with antidepressant drugs . Br Med J 1964;;2:1465-1466.
Ritchie P:  Neuroleptic malignant syndrome, correspondence . Br Med J 1983;;287:561.
Mirchandani H, Reich LE:  Fatal malignant hyperthermia as a result of ingestion of tranylcypromine (Parnate) combined with white wine and cheese . J Forensic Sci 1985;;30:217-220.
Cooper TB, Robinson DS, Nies A:  Phenelzine measurement in human plasma: A sensitive GLC-ECD procedure . Communications Psychopharmacol 1978;;2:505-512.
Rosenberg H, Reed S:  In vitro contracture tests for susceptibility to malignant hyperthermia . Anesth Analg 1983;;62:415-420.
Goodman L, Gilman A: The Pharmacologic Basis of Therapeutics , ed 6. New York, Macmillan Publishing Co Inc, 1980;, pp 427-430.
Caroff SN:  The neuroleptic malignant syndrome . J Clin Psychiatry 1980;;41:79-83.
Henderson VW, Wooten GF:  Neuroleptic malignant syndrome: A pathogenic role for dopamine receptor blockade? Neurology 1981;; 31:132-137.
Caroff S, Rosenberg H, Gerber JC:  Neuroleptic malignant syndrome and malignant hyperthermia . Lancet 1983;;1:244.
Britt BA, Kalow W:  Malignant hyperthermia: A statistical review . Can Anaesth Soc J 1970;;17:293-315.
Nelson TE, Flewellen EH:  The malignant hyperthermia syndrome . N Engl J Med 1983;; 309:416-418.
Gronert GA:  Malignant hyperthermia . Anesthesiology 1980;;53:395-423.
Ryan JF:  Malignant hyperpyrexia: Diagnosis and treatment , in: 31st Annual Refresher Course Lectures . Park Ridge, Ill, American Society of Anesthesiologists, 1980;, lecture 237, pp 1-3.
Kolb ME, Horne ML, Martz R:  Dantrolene in human malignant hyperthermia: A multicenter study . Anesthesiology 1982;;56:254-262.
Coons DJ, Hillman FJ, Marshall RW:  Treatment of neuroleptic malignant syndrome with dantrolene sodium: A case report . Am J Psychiatry 1982;;139:944-945.
Smithson WA, Gronert GA, Moss KK:  Dantrolene and potentially fatal hyperthermia secondary to L-asparaginase . Cancer Treat Rep 1983;;67:318-319.
Lydiatt JS, Hill GE:  Treatment of heat stroke with dantrolene . JAMA 1981;;246:41-42.
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