Observation and patient disposition after SNRI poisoning

See specific observation and patient disposition advice for Tramadol poisoning and Tapentadol poisoning.

Admit patients with serotonergic toxidrome due to serotonin and noradrenaline reuptake inhibitor (SNRI) poisonings to a critical care unit.

For most SNRI poisonings, patients can be discharged if they remain asymptomatic for:

• at least 6 hours after ingestion of an immediate-release SNRI preparation
• at least 16 hours after ingestion of a modified-release SNRI preparation.

If cardiotoxicity or QT-interval prolongation occurs following SNRI poisoning, observe patients with continuous ECG monitoring and serial 12-lead ECGs for at least 6 hours after ingestion of an immediate-release preparation or at least 16 hours after ingestion of a modified-release preparation.

Patients who ingest more than 5 g of venlafaxine are at increased risk of delayed seizures. Observe them for at least 24 hours after ingestion.

Sedative drugs can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after discharge.