Prolonged Anticholinergic Delirium Following Antihistamine Overdose

Scott, James G.; Pache, David; Keane, Greg; Buckle, Helen; O’Brien, Natalie

doi:10.1080/10398560601147020

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…Promethazine has been reported in SUD clients and is misused as a substitute for another drug or to increase the effects of inadequate dosing (i.e., to delay the onset of opioid withdrawal or to potentiate the sedating effect of benzodiazepines/Z-drugs) (13,19,20,103,129,130,132,133). Overdose of promethazine is associated with an antimuscarinic delirium, agitation, and neuroleptic malignant syndrome (100, 102,104,133). Scott et al (104) recorded a promethazineinduced delirium treated with physostigmine intravenously, which reversed both central and peripheral anticholinergic effects, similarly to a polydrug overdose due to the ingestion of DPH (94).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the use of promethazine injection in opioid users was reported as a substitute for heroin or to increase the effects of an inadequate heroin dosing (103). A case of drug-induced delirium deriving from the coingestion of high-dose promethazine, cyproheptadine, and fluvoxamine in a young girl was recorded (104). Finally, a case of promethazine dependence and withdrawal after 2year continuing use of a promethazine-cough mixture was described (105).…”

Section: Diphenhydraminementioning

confidence: 99%

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Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

et al. 2021

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Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused.Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine.Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261).Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported.Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.

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Section: Discussionmentioning

confidence: 99%

Section: Diphenhydraminementioning

confidence: 99%

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

et al. 2021

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“…Severe adverse effects may include agitation, delirium, psychosis, seizures, coma, dysrhythmias including torsades de pointe and anticholinergic effects (Table 50.3 ). Other medications that undergo hepatic metabolism may complicate the course of delirium, either by competing for the same metabolizing isoenzymes or by directly inhibiting their functional capacity [ 207 ]. Administration of other medications with anticholinergic properties should be avoided.…”

Section: Antihistaminesmentioning

confidence: 99%

Toxic Ingestions

Sullivan

McDonald

2014

Pediatric Critical Care Medicine

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IntroductionEven with public heightened awareness for potential home toxin exposures, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age [ 1 ]. This represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % of exposures and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %) [ 1 ]. The intensivist must be prepared to care for the children who have serious and sometimes life-threatening exposures. AbstractDespite the public's heightened awareness of potential toxin exposures in children, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, the United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age which represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %). The intensivist must be prepared to care for children who have serious and sometimes life-threatening exposures. Supportive care is the mainstay of therapy because many poisons have no specifi c antidote. Much of the current clinical practices for treating the poisoned patient are based on anecdotal reports because there are limited evidenced-based clinical trials that provide guidance for treatment, safety, and outcome.

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“…A number of first-generation antihistamines such as promethazine are metabolized by CYP2D6, resulting in potential interactions with psychoactive medications (5). Clinically significant interactions have been documented with fluvoxamine and promethazine resulting in excessive sedation and anticholinergic delirium (57). Other firstgeneration antihistamines such as astemizole and terfenadine are metabolized by CYP3A4 (5).…”

Section: Antihistaminesmentioning

confidence: 99%

The clinical significance of drug interactions between dermatological and psychoactive medications

Frew

2014

Dermatol Ther

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Dermatological disease is commonly associated with psychological morbidity because of its visible nature. The burden of living with a chronic dermatological illness can contribute to the development of psychiatric illness and conversely, such conditions can result in the exacerbation of preexisting dermatological disease. It may also reduce a patient's compliance to treatment, result in loss to follow-up and a decreased level of functioning and quality of life. In dermatological patients who suffer from psychiatric symptoms, medical management used in their treatment may have significant interactions with systemic medications used to treat their dermatological condition. A well-known example of this is lithium's ability to exacerbate psoriasis. Such interactions can result in suboptimal treatment of their psychiatric and/or dermatological condition. The present paper aimed to review the literature for documented interactions and the level of clinical significance between dermatological and psychoactive medications. Such information is clinically relevant to the practicing dermatologist in order to minimize adverse effects and drug-drug interactions in dermatological patients.

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Prolonged Anticholinergic Delirium Following Antihistamine Overdose

Cited by 12 publications

References 20 publications

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

Toxic Ingestions

The clinical significance of drug interactions between dermatological and psychoactive medications

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