Journal of Forensic and Legal Medicine 2008-01-01

Fatal intoxication with milnacipran

Laurent Fanton, Fabien Bévalot, Habdelhamid Grait, Catherine Le Meur, Yvan Gaillard, Daniel Malicier, Laurent Fanton, Fabien Bévalot, Habdelhamid Grait, Catherine Le Meur, Yvan Gaillard, Daniel Malicier

Index: J. Forensic Leg. Med. 15(6) , 388-90, (2008)

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Abstract

The antidepressant milnacipran is a double serotonin/noradrenalin reuptake inhibitor. The low reported incidence of intoxication indicates excellent tolerance in comparison with tricyclic and second generation antidepressants. We report a fatal intoxication associating milnacipran, at blood levels (femoral = 21.5 mg/l, cardiac = 20 mg/l) 40-fold higher than the usual treatment concentration, and six other molecules (fluoxetine, norfluoxetine, sertraline, cyamemazine, nordazepam and oxazepam) at therapeutic levels. To the best of our knowledge, this is the first reported fatal intoxication involving milnacipran.