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Review
. 2024 Mar 15;103(11):e37612.
doi: 10.1097/MD.0000000000037612.

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

Affiliations
Review

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

Yeran Hwang et al. Medicine (Baltimore). .

Abstract

Lipid emulsion has been shown to effectively relieve refractory cardiovascular collapse resulting from toxic levels of nonlocal anesthetics. The goal of this study was to examine the effect of lipid emulsions on neuropsychiatric drug-induced toxicity using relevant case reports of human patients, with a particular focus on the Glasgow Coma Scale (GCS) score and corrected QT interval, to analyze drugs that frequently require lipid emulsion treatment. The following keywords were used to retrieve relevant case reports from PubMed: "antidepressant or antipsychotic drug or amitriptyline or bupropion or citalopram or desipramine or dosulepin or dothiepin or doxepin or escitalopram or fluoxetine or haloperidol or olanzapine or phenothiazine or quetiapine or risperidone or trazodone" and "lipid emulsion or Intralipid." Lipid emulsion treatment reversed the corrected QT interval prolongation and decreases in Glasgow Coma Scale scores caused by toxic doses of neuropsychiatric drugs, especially lipid-soluble drugs such as amitriptyline, trazodone, quetiapine, lamotrigine, and citalopram. The log P (octanol/water partition coefficient) of the group which required more than 3 lipid emulsion treatments was higher than that that of the group which required less than 3 lipid emulsion treatments. The main rationale to administer lipid emulsion as an adjuvant was as follows: hemodynamic depression intractable to supportive treatment (88.3%) > lipophilic drugs (8.3%) > suspected overdose or no spontaneous breathing (1.6%). Adjuvant lipid emulsion treatment contributed to the recovery of 98.30% of patients with neuropsychiatric drug-induced toxicity. However, further analyses using many case reports are needed to clarify the effects of lipid emulsion resuscitation.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow chart for retrieving clinical case reports on lipid emulsion treatment as an adjuvant therapy for systemic neuropsychiatric (antidepressants, antipsychotics, benzodiazepines, and anticonvulsants) drug toxicity based on a PubMed keyword search. “n” indicates the number of articles.
Figure 2.
Figure 2.
Distribution of lipid solubility (log P: log [octanol/water partition coefficient]) of neuropsychiatric drugs (total number of drugs: 39) that caused toxicity in patients undergoing lipid emulsion treatment. N/A = not available.
Figure 3.
Figure 3.
Comparison of lipid solubility (log P: log [octanol/water partition coefficient]) for the groups (including duplicates) that required more than or less than 3 lipid emulsion treatments; the total numbers of drugs in each group were 75 and 33, respectively. Data are shown as the median ± interquartile range (25–75%); ***P < .001 vs group which required less than 3 lipid emulsion treatments.
Figure 4.
Figure 4.
Effect of lipid emulsion on the GCS scores in patients (n = 12) undergoing lipid emulsion treatment for neuropsychiatric drug toxicity. Data are shown as the median ± interquartile range (25–75%); n indicates the number of patients and **P = .0037 vs before lipid emulsion treatment. GCS = Glasgow Coma Scale.
Figure 5.
Figure 5.
Effect of lipid emulsion on the prolonged corrected QTc interval (QTc) in patients undergoing lipid emulsion treatment for drug toxicity related to a single neuropsychiatric drug (A, n = 11) or single and multiple drugs (B, n = 16). Data are shown as the mean ± standard deviation; n indicates the number of patients. ***P < .001 vs before lipid emulsion treatment.

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