Esopam Overdosage

Many of the toxic effects are mediated by stimulation of the 5-HT₂ receptors causing excessive serotonin effect or serotonin syndrome. Serotonin toxicity may develop at therapeutic doses, particularly if another medication that increases CNS serotonin is used concomitantly.
Management of mild to moderate toxicity: Most patients require only supportive care. Control agitation and confusion with either benzodiazepines or serotonin antagonist such as cyproheptadine or chlorpromazine. Manage mild hypotension with IV fluids. Hypertension and tachycardia are generally mild and well tolerated, and do not require specific treatment.
Management of severe toxicity: Early intubation, neuromuscular paralysis, ventilation assistance, and aggressive cooling should be performed if the patient presents with respiratory depression, severe muscle rigidity, and severe hyperthermia. Adequate circulatory support with IV fluids and vasopressors (if needed) should be assured if patient presents with circulatory collapse.
Treat seizures with benzodiazepines; use barbiturates or propofol for recurrent seizures. Patients with wide-complex dysrhythmias should be treated with hypertonic sodium bicarbonate boluses. Although QTc interval prolongation is well described, torsade de pointes is rare. If torsade de pointes occurs, patients should be treated using standard interventions (magnesium sulfate 2 g IV, external or internal cardiac pacing). Because citalopram is lipid-soluble, consider intravenous lipid therapy for patients with ventricular dysrhythmias or hypotension who do not respond to other therapies.