Mori K, Kamijo Y, Doi T, Abe H, Takeuchi I. Severe venlafaxine poisoning successfully rescued with veno-arterial extracorporeal membrane oxygenation: A case report. World J Clin Cases 2025; 13(33): 113560 [PMID: 41356085 DOI: 10.12998/wjcc.v13.i33.113560]
Corresponding Author of This Article
Kurumi Mori, MD, Department of Emergency and Critical Care Medicine, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan. e123082b@yokohama-cu.ac.jp
Research Domain of This Article
Toxicology
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 26, 2025 (publication date) through Jan 10, 2026
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Mori K, Kamijo Y, Doi T, Abe H, Takeuchi I. Severe venlafaxine poisoning successfully rescued with veno-arterial extracorporeal membrane oxygenation: A case report. World J Clin Cases 2025; 13(33): 113560 [PMID: 41356085 DOI: 10.12998/wjcc.v13.i33.113560]
Kurumi Mori, Department of Emergency and Critical Care Medicine, Yokohama City University Medical Center, Yokohama 232-0024, Kanagawa, Japan
Kurumi Mori, Tomoki Doi, Department of Emergency Medicine, Yokosuka Kyosai Hospital, Yokosuka 238-8558, Kanagawa, Japan
Yoshito Kamijo, Department of Clinical Toxicology, Saitama Medical University, Saitama 3500495, Japan
Hiroko Abe, BioDesign Co., Ltd., Tokyo 113-0033, Tōkyō, Japan
Ichiro Takeuchi, Department of Emergency and Critical Care Medicine, Yokohama City University School of Medicine, Yokohama 232-0024, Kanagawa, Japan
Author contributions: Mori K contributed to the conception and design of the study, patient management, and drafting of the manuscript; Kamijo Y supervised the clinical toxicology aspects and critically revised the manuscript for important academic content; Doi T assisted with patient care; Abe H supported the toxicological analysis; Takeuchi I contributed to the overall supervision of the study and editing of the manuscript; All authors have reviewed and approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s family for publication of this case report and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kurumi Mori, MD, Department of Emergency and Critical Care Medicine, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan. e123082b@yokohama-cu.ac.jp
Received: August 29, 2025 Revised: September 25, 2025 Accepted: November 5, 2025 Published online: November 26, 2025 Processing time: 84 Days and 23.5 Hours
Abstract
BACKGROUND
Venlafaxine, a serotonin-norepinephrine reuptake inhibitor, is widely prescribed for the treatment of major depressive disorder. At therapeutic dose, it is generally safe, with a low incidence of adverse effects. However, massive venlafaxine ingestion can cause serious cardiotoxicity, leading to life-threatening arrhythmias.
CASE SUMMARY
A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam. On admission, 2 hours post-ingestion, she presented only with mild QTc prolongation. At 4 hours post-ingestion, she developed a generalized tonic-clonic seizure. Following endotracheal intubation, intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube. At 15 hours post-ingestion, she developed ventricular tachycardia that rapidly progressed to refractory ventricular fibrillation, which was successfully treated with veno-arterial extracorporeal membrane oxygenation. Toxicological analysis revealed serum venlafaxine and O-desmethylvenlafaxine concentrations 17 µg/mL and 10 µg/mL, respectively, at 15 hours post-ingestion.
CONCLUSION
In cases of massive venlafaxine ingestion, continuous intensive monitoring, particularly of QTc, is essential for at least 24 hours, even when initial clinical signs are mild. If refractory ventricular arrhythmias occur, prompt initiation of veno-arterial extracorporeal membrane oxygenation should be considered.
Core Tip: A 31-year-old woman ingested a massive dose of venlafaxine (14.8 g) and initially showed only mild QTc prolongation. However, she developed ventricular fibrillation 15 hours post-ingestion. She was successfully managed with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This case highlights the potential for delayed but life-threatening cardiotoxicity in venlafaxine overdose and demonstrates the utility of VA-ECMO as a life-saving intervention. Continuous electrocardiographic monitoring beyond the early phase is essential even when initial findings are mild.
