Circulation

Treatment for hypotension

Cardiovascular complications are uncommon after SSRI poisonings. If hypotension is problematic, start intravenous fluid resuscitation.

Treatment for QT-interval prolongation and torsades de pointes

Continuous ECG monitoring and serial 12-lead ECGs are indicated for:

• citalopram poisonings of more than 800 mg if activated charcoal was given within 4 hours after ingestion, or more than 600 mg if activated charcoal was not given within 4 hours after ingestion
• escitalopram poisonings of more than 400 mg if activated charcoal was given within 4 hours after ingestion, or more than 300 mg if activated charcoal was not given within 4 hours after ingestion.

If there is evidence of QT-interval prolongation on ECG or torsades de pointes develops, manage urgently according to Treatment for QT-interval prolongation and torsades de pointes.

Continue serial 12-lead ECGs for 12 hours or until the QT interval has normalised. ECG monitoring is not routinely required for poisonings of other SSRIs.