The following is a summary of the “Successful Treatment of Amoxapine-Induced Intractable Seizures With Intravenous Lipid Emulsion,” published in the January 2023 issue of Emergency Medicine by Matsuoka, et al.

As a second-generation tricyclic antidepressant, amoxapine carries a higher seizure risk than other medications. In addition, amoxapine can be extremely toxic, even fatal, if given in high enough doses. Therefore, if amoxapine toxicity occurs, seizures must be stopped immediately. However, these patients frequently experience intractable seizures. We present a case of amoxapine poisoning-induced intractable seizures that responded well to intravenous lipid emulsion (ILE).

A depressed 44-year-old woman tried to kill herself by swallowing 3.0 g of amoxapine. Her seizures persisted despite early treatment with intravenous diazepam. Both levetiracetam and phenobarbital were given, but the seizures continued. As a result, the ILE injection lasted longer than a minute. The patient’s status seizures stopped 2 minutes after the ILE was given. Within 30 minutes of receiving ILE, the seizures returned but were eliminated upon receiving ILE again.

Amoxapine poisoning is a possible indication of ILE’s usefulness. For cases of amoxapine poisoning with a high mortality rate, emergency room doctors may consider ILE as a supportive treatment option. However, careful implementation of ILE is required, including close tracking of cumulative doses and adverse effects.