Pharmacobezoars??? The Irony of the Antidote: First Case Report of Nifedipine XL Bezoar

Stack, Philip E.; Patel, Nikhil; Young, Mark; Ferslew, Kenneth E.; Thomas, Eapen

doi:10.1097/00004836-199410000-00020

Cited by 22 publications

(5 citation statements)

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“…Except for chronic diarrhea (the causes of which remain uncertain), the gastrointestinal symptoms observed in our patient were similar to those described in patients with symptomatic nifedipine GITS bezoar 3–8 . We hypothesized that the retention of the nifedipine tablets could have contributed to some gastrointestinal symptoms observed in our patient, but some symptoms could also have been caused by underlying disease (especially colonic ischemia).…”

supporting

confidence: 75%

Severe Gastrointestinal Dysfunction and Retention of Extended Release Nifedipine Tablets

Smitz

Bonnet

Delporte

1998

J American Geriatrics Society

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supporting

confidence: 75%

Severe Gastrointestinal Dysfunction and Retention of Extended Release Nifedipine Tablets

Smitz

Bonnet

Delporte

1998

J American Geriatrics Society

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“…Nine published reports link extended-release nifedipine to bezoar formation (Table 1). [4][5][6][7][8][9][10][11][12] These reports involve patients taking 30-mg, 60mg, and 90-mg tablets. The pathogenesis of bezoars is influenced by the ingested material as well as the gastric environment.…”

Section: Discussionmentioning

confidence: 99%

“…3 The insoluble outer membrane of extended-release nifedipine can promote bezoar formation, and several published reports describe extended-release nifedipine bezoars in patients who were taking this agent for therapeutic purposes ( Table 1). [4][5][6][7][8][9][10][11][12] Although an intentional overdose of nifedipine may have a high probability of bezoar formation, to our knowledge this has not been previously reported.…”

mentioning

confidence: 99%

Bezoar Formation Requiring Endoscopic Removal After Intentional Overdose of Extended-Release Nifedipine

et al. 2006

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A 61-year-old Caucasian woman was transported to the emergency department after intentionally ingesting several different prescription drugs. She had been found by her husband in an unconscious state with empty bottles of extended-release venlafaxine, extended-release nifedipine, sertraline, and atorvastatin. She was intubated in the emergency department and transferred to the intensive care unit. After 36 hours in the intensive care unit, she was stabilized and brought to a general medical ward. She later developed profound recurrent hypotension with systolic blood pressures ranging from 40-70 mm Hg and diastolic blood pressures of 0-40 mm Hg. She was readmitted to the intensive care unit, where a computed tomography scan revealed a mass in her stomach. A gastroenterology consultation was obtained, and an esophagogastroduodenoscopy (EGD) was performed, during which a large drug bezoar was discovered and removed. The drugs were identified as extended-release nifedipine with a few granules of extended-release venlafaxine. Unfortunately, the patient died 3 days after the EGD from multisystem organ failure related to the overdose. Clinicians who encounter drug overdoses should be aware of the possibility of drug bezoar formation and should consider endoscopic removal as a potential treatment option.

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“…Two reported patients developed concretions in the stomach, one of whom had previously undergone gastroplasty [42] and the other a Billroth II procedure. [43] In both cases, the type of nifedipine ingested (the nifedipine 'gastrointestinal therapeutic system') achieves sustained release of drug via a biologically inert component of the capsule © Adis International Limited. All rights reserved.…”

Section: With Coexisting Risk Factorsmentioning

confidence: 99%

Bezoars Implicated Drugs and Avoidance Strategies

Thompson

Iredale

1996

Drug Safety

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A wide variety of drugs or combinations of drugs have the potential to form bezoars. In the majority of patients presenting with bezoars there is a clear predisposing factor. This article highlights those drugs or groups of drugs which have been implicated in bezoar formation. Although bezoars are rare, it is important that the clinician is aware of the possibility of their development, particularly in susceptible individuals. This is because bezoars often develop in the elderly and in those with serious coexistent disease. They may be difficult to diagnose and recourse to laparotomy is frequently required to treat them. As a result, they are associated with a significant morbidity and mortality.

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Pharmacobezoars??? The Irony of the Antidote: First Case Report of Nifedipine XL Bezoar

Cited by 22 publications

References 0 publications

Severe Gastrointestinal Dysfunction and Retention of Extended Release Nifedipine Tablets

Severe Gastrointestinal Dysfunction and Retention of Extended Release Nifedipine Tablets

Bezoar Formation Requiring Endoscopic Removal After Intentional Overdose of Extended-Release Nifedipine

Bezoars Implicated Drugs and Avoidance Strategies

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