The effect of decontamination procedures on the pharmacokinetics of venlafaxine in overdose

Clin Pharmacol Ther. 2009 Oct;86(4):403-10. doi: 10.1038/clpt.2009.114. Epub 2009 Jul 15.

Abstract

The aim of this work was to investigate the pharmacokinetics (PK) of venlafaxine in overdose and the effects of single-dose activated charcoal (SDAC) and whole-bowel irrigation (WBI), alone or in combination, as methods of decontamination. The data included 339 concentration-time points from 76 venlafaxine overdose events (median dose 2,625 (150-13,500 mg)); 69 were slow-release doses. SDAC, WBI, a combination of both, or no decontamination were administered to patients as decided by the treating clinician. The data were modeled using WinBUGS (Windows Bayesian Inference Using Gibbs Sampling). A one-compartment model with first-order input and elimination provided an adequate description of the data. SDAC increased clearance (CL) of venlafaxine by 35%, and SDAC and WBI combined reduced the fraction absorbed by 29%. However, the latter produced a greater reduction in maximum plasma concentration (C(max)) for a similar drop in area under the plasma concentration-time curve (AUC). Both SDAC alone, and a combination of SDAC and WBI, decreased the AUC after venlafaxine overdose, but the combination may be more beneficial because it reduces peak concentrations to a greater extent.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Area Under Curve
  • Charcoal / administration & dosage
  • Charcoal / therapeutic use*
  • Cyclohexanols / pharmacokinetics*
  • Cyclohexanols / poisoning*
  • Decontamination / methods*
  • Dose-Response Relationship, Drug
  • Drug Overdose / metabolism
  • Female
  • Humans
  • Lower Gastrointestinal Tract
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Models, Biological
  • Prospective Studies
  • Selective Serotonin Reuptake Inhibitors / pharmacokinetics*
  • Selective Serotonin Reuptake Inhibitors / poisoning*
  • Therapeutic Irrigation
  • Venlafaxine Hydrochloride
  • Young Adult

Substances

  • Cyclohexanols
  • Serotonin Uptake Inhibitors
  • Charcoal
  • Venlafaxine Hydrochloride