Effects of self poisoning with maprotiline.

Knudsen, Kai; Heath, Andrew

doi:10.1136/bmj.288.6417.601

Cited by 54 publications

(18 citation statements)

References 15 publications

(1 reference statement)

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“…Suchard points out, however, that by excluding patients with prior ECG changes, the study may have selected for patients with less severe cyclic antidepressant poisoning. Suchard also points out that, in most studies of physostigmine use with cyclic antidepressant ingestion, seizures rather than cardiac toxicity are the more prevalent complication [6,9]. The author concludes that, in the face of cyclic antidepressant ingestion, the QRS duration should be used more as a surrogate marker for severity of the ingestion rather than a contraindication to physostigmine use.…”

Section: Recent Literaturementioning

confidence: 86%

“…Others have suggested that widened QRS and asystole are likely terminal events in severe cyclic antidepressant poisoning rather than from physostigmine administration. This was supported by a study in 1984 which demonstrated the same complications in patients with cyclic antidepressant overdose not treated with physostigmine [9]. The review also cites more recent studies, including the study by Burns et al [6] in which patients with cyclic antidepressant ingestion were not excluded from receiving physostigmine unless they exhibited ECG changes (PR interval >200 ms or QRS interval >100 ms).…”

Section: Recent Literaturementioning

confidence: 90%

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Physostigmine: is there a role for this antidote in pediatric poisonings?

Frascogna

2007

Current Opinion in Pediatrics

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In the proper clinical situation such as pure anticholinergic overdose with severe symptoms, physostigmine can be beneficial. The potential for side effects is not insignificant, and the antidote should be used with caution in any patient with unknown ingestions or those with cardiac conduction defects. More research is needed, especially involving children, before we will fully understand the indications and toxicities associated with physostigmine.

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Section: Recent Literaturementioning

confidence: 86%

Section: Recent Literaturementioning

confidence: 90%

Physostigmine: is there a role for this antidote in pediatric poisonings?

Frascogna

2007

Current Opinion in Pediatrics

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“…Interestingly, this drug was initially thought to have less epileptogenic effect than other available antidepressants, based on studies in animal models (Trimble 1978); however, in a subsequent retrospective study in hospitalised depressed patients, the risk of seizures induced by therapeutic doses of maprotiline was found to be much higher (15.6%) than that calculated in patients treated with conventional tricyclic antidepressants (2.2%) [Bryan et al 1983]. From a toxicological point of view, maprotiline is therefore similar to conventional antidepressants (Knudsen & Heath 1984) as confirmed by Crome and Newman's (l979b) study of intoxications with antidepressants, in which a very high incidence of convulsions (25%) was found in subjects taking an overdose of maprotiline.…”

Section: Newer Antidepressant Drugsmentioning

confidence: 92%

Clinical Features, Pathogenesis and Management of Drug-Induced Seizures

1990

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Many classes of pharmacological agents have been implicated in cases of drug-induced seizures. The list includes antidepressant drugs, lithium salts, neuroleptics, antihistamines (H1-receptor antagonists), anticonvulsants, central nervous system stimulants, general and local anaesthetics, antiarrhythmic drugs, narcotic and non-narcotic analgesics, non-steroidal anti-inflammatory drugs, antimicrobial agents, antifungal agents, antimalarial drugs, antineoplastic drugs, immunosuppressive drugs, radiological contrast agents and vaccines. For each of these classes of drugs, this article offers a revision of the literature and emphasises in particular the frequency of the adverse reaction, its clinical presentation, its presumed epileptogenic mechanism and the therapeutic strategy for the management of drug-induced seizures. An attempt is also made to distinguish seizures induced by standard dosages from those provoked by accidental or self-induced intoxication. For some classes of drugs such as antidepressants, neuroleptics, central nervous system stimulants (e.g. theophylline, cocaine, amphetamines) and beta-lactam antibiotics, seizures are a well recognised adverse reaction, and a large body of literature has been published discussing exhaustively the major aspects of the issue; sufficient data are available also for the other classes of pharmacological agents mentioned above. In contrast, several other drugs [e.g. allopurinol, digoxin, cimetidine, protirelin (thyrotrophin releasing hormone), bromocriptine, domperidone, insulin, fenformin, penicillamine, probenecid, verapamil, methyldopa] have not been studied thoroughly under this aspect, and the only source of information is the occasional case report. This review does not address the issue of seizures induced by drug withdrawal.

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“…4 Time (days) to discharge from first dose of physostigmine. Unfilled circle indicates one dose given, admitted, n=16; inverted triangle indicates one dose given, discharged, n=14; filled circle indicates one dose given, admitted, n=9; filled inverted triangle indicates more than one dose given, discharged, n=5 rhea, bradycardia, emesis, salivation, and seizures may result from or be exacerbated by physostigmine administration [17,18]. Any evidence of seizure or significant bradycardia in the absence of beta-adrenergic antagonists should be considered a contraindication to physostigmine administration.…”

Section: Discussionmentioning

confidence: 99%

Timing and Frequency of Physostigmine Redosing for Antimuscarinic Toxicity

Rosenbaum

Bird

2010

J. Med. Toxicol.

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We sought to determine how frequently antimuscarinic-poisoned patients receiving physostigmine receive multiple doses of physostigmine, the length of time between physostigmine doses, and what impact multiple doses of physostigmine have on the disposition and total length of hospital stay. We performed a retrospective chart review of patients given physostigmine for likely antimuscarinic toxicity. A total of 45 patients met inclusion criteria. We abstracted patient demographics, vital signs, physical exam findings, electrocardiograms, the timing and dose of physostigmine, the implicated antimuscarinic agents, and disposition from the hospital. We counted the number of patients who required multiple physostigmine doses and calculated the time to repeat dosing. Fourteen of the 45 patients (31%) given physostigmine for antimuscarinic toxicity received multiple doses: nine patients (20%) received two doses, three patients (6.6%) received three doses, and two patients (4.4%) received four doses. Less than 5.5 h elapsed between sequential physostigmine doses, and less than 6.5 h elapsed between the first and last dose. Forty-five percent of patients receiving one dose of physostigmine were discharged from the emergency department (ED) and 36% of patients receiving more than one dose of physostigmine were discharged from the ED. Whether admitted or discharged, there was no statistically significant difference in the length of hospital stay between patients receiving one or multiple doses of physostigmine.Repeated physostigmine administration is not frequently needed in medication-induced antimuscarinic toxicity. Patients are not likely to require further physostigmine redosing more than 6.5 h from their first dose.

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Effects of self poisoning with maprotiline.

Cited by 54 publications

References 15 publications

Physostigmine: is there a role for this antidote in pediatric poisonings?

Physostigmine: is there a role for this antidote in pediatric poisonings?

Clinical Features, Pathogenesis and Management of Drug-Induced Seizures

Timing and Frequency of Physostigmine Redosing for Antimuscarinic Toxicity

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