Introduction: Clozapine is a frequently prescribed atypical antipsychotic drug. Various case reports documented the successful recovery of acute antipsychotics toxicity in association with the administration of intralipid emulsion (ILE). Aim: This study aimed to assess the adjuvant therapeutic role of SMOF Lipid administration on the outcomes of acute clozapine poisoning. Methods: Forty patients with acute clozapine poisoning were randomly allocated into two equal groups. The control group received the standard supportive treatment only, whereas the intervention group received the standard supportive treatment plus SMOF Lipid 20% infusion. All patients were subjected to history taking, full clinical examination, and laboratory investigations. The study outcomes were evaluated. Results: The mean Glasgow Coma Scale (GCS) at 6 hours (13.1 ± 2.3 vs 9.2 ± 2, p < 0.001) and 12 hours (14.3 ± 1.5 vs 9.6 ± 2, p < 0.001) after admission was significantly higher in the intervention group compared to the control group. The intervention group showed a significantly lower frequency of prolonged QTc interval 12 hours after admission (p = 0.003), as well as a significantly shorter hospital stay (p < 0.001). Conclusions: SMOF Lipid infusion seemed to have improved GCS, the prolonged QTc interval, and shortened the length of hospital stay. Furthermore, there were no adverse effects related to its administration.
Background: Antipsychotics toxicity is one of the top five substances most frequently included in human poisoning. Various case reports documented successful use of intravenous lipid emulsion (ILE) in the management of acute antipsychotics poisoning. Aim: The aim of this study was to assess the efficacy and safety of ILE as adjuvant therapy for acute antipsychotic poisoning. Patients and methods: Forty patients presented with moderate to severe acute antipsychotic poisoning were randomly allocated into two equal groups. The control group was given the standard treatment only while the intervention group was given the standard treatment plus ILE infusion. For all patients, history, clinical examination, ECG, and laboratory investigations were done. The safety and efficacy outcomes were evaluated. Results: results revealed that the median Glasgow Coma Scale assessed at 6 and 12 hours after admission was significantly higher in the intervention group compared to the control group. Both corrected QT intervals measured 12 hours after admission and period of hospital stay were significantly shorter in the intervention group compared to the control group. During follow-up of the intervention group, there were no significant differences between serum triglycerides levels, liver enzymes and, platelet count measured at admission and 12 hours later. Conclusion: It was concluded that ILE was a safe and effective therapy for acute antipsychotic poisoning.
We read the letter to the editor entitled "Effect of lipid emulsion on acute clozapine poisoning-induced QT prolongation." We want to thank the authors for their concern and appreciation of our randomized clinical trial article entitled "Intravenous lipid emulsion as an adjuvant therapy of acute clozapine poisoning" which has been recently published on line in Human and Experimental Toxicology.We agree with the authors discussion about the possible roles of lipid emulsion in decreasing the prolonged QT interval induced by clozapine toxicity, and the need for further studies to determine the optimal dosage of lipid emulsions as an adjuvant therapy and the optimal timing of lipid emulsion administration in toxicity induced by non-local anesthetic drugs, including clozapine.The authors highlighted a difference between the effect size of lipid emulsion treatment as an antidote in acute non-local anesthetic toxicity, lipid emulsion only slightly increased the GCS (calculated Cohen's effect size: 0.63, 95% confidence interval: À0.101 to 1.366) 1 and our findings. Our study 2 reported that lipid emulsion treatment significantly improved the GCS (Cohen's effect size: 2.65, 95% confidence interval: 1.808-3.509) in acute clozapine poisoning. In our view, this difference is attributed to the heterogenous poison types with various inherent toxicity included in the previous study of Taftachi et al.
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