Retrospective analysis of venlafaxine-induced hypoglycemia in patients with overdose

Introduction: Recent publications relate the presence of hypoglycemia in venlafaxine (VLX) poisoning depending on the dose. Our aim was to analyze the clinical characteristics of patients who presented hypoglycemia induced by VLF overdose. Patients and methods: Retrospective study carried out in the Balearic Islands (2020-2023). Inclusion criteria: serum concentrations of VLX + O-desmethyl-venlafaxine (O-VLX) > 800 ng/mL. The characteristics of patients with and without hypoglycemia were compared. Results: Twenty-one patients were included, 8 (38.1%) with hypoglycemia. No differences were found in the doses referred to in both groups. Peak concentrations of VLX + O-VLX (ng/mL) were 9,783 [4,459-17,9761 in patients with hypoglycemia and 1,413 [930-1,7191 in patients without hypoglycemia (p < 0.0001). The presence of hypoglycemia was associated with: lower age and level of consciousness; and higher frequency of suicide attempts, seizures, mydriasis, tachycardia and serotonin syndrome, invasive respiratory support, fluid therapy and ICU admission (p < 0.05). Conclusions: The detection of hypoglycemia in a VLX overdose case is a readily available marker to suspect the severity of the patient. In any case, serum concentrations when available allow us to confirm intoxication. (c) 2023 Published by Elsevier Espana, S.L.U.