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Chiew AL, Holford AG, Chan BSH, Isoardi KZ. Rivastigmine for the management of anticholinergic delirium. Clin Toxicol (Phila) 2024; 62:82-87. [PMID: 38465631 DOI: 10.1080/15563650.2024.2319854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Anticholinergic agents are commonly taken in overdose, often causing delirium. The spectrum of anticholinergic delirium ranges from mild agitation to severe behavioural disturbance. Physostigmine is an effective treatment for anticholinergic delirium, but its availability is limited. As rivastigmine is readily available, it has been used to manage anticholinergic delirium; however, there is limited research investigating its use. METHOD This was a retrospective review of patients with anticholinergic delirium treated in two toxicology units with rivastigmine (oral capsule or transdermal patch) from January 2019 to June 2023. The primary outcome was the use of further parenteral treatment (sedation or physostigmine) for delirium post rivastigmine administration. RESULTS Fifty patients were administered rivastigmine for the management of anticholinergic delirium. The median age was 36 years (interquartile range: 25-49 years) and 27 (54 per cent) were females. Features consistent with anticholinergic toxicity included tachycardia in 44 (88 per cent) and urinary retention requiring catheterisation in 40 (80 per cent). Forty-three patients (86 per cent) were treated with physostigmine before rivastigmine administration. Twenty-two were managed with transdermal rivastigmine (most commonly 9.5 mg/24 hour patch), and 28 with oral rivastigmine 6 mg. Further parenteral sedation and/or physostigmine treatment were required more often in patients given transdermal than oral rivastigmine [16/22 (73 per cent) versus 9/28 (32 per cent), P = 0.010)]. No patients had bradycardia or gastrointestinal symptoms following rivastigmine administration. One patient with a history of epilepsy had a seizure, 1.5 hours post physostigmine administration and 7 hours post transdermal rivastigmine. DISCUSSION Rivastigmine has been increasingly used for the management of patients with anticholinergic delirium, due to the lack of availability of physostigmine. In this case series, rivastigmine transdermal patch appeared to be less effective than oral rivastigmine capsules, likely due to its slow onset of action and/or insufficient dose. CONCLUSION Rivastigmine can be used to treat anticholinergic delirium. In our case series oral rivastigmine appeared more effective than transdermal rivastigmine.
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Affiliation(s)
- Angela L Chiew
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, Australia
- Faculty of Medicine, Prince of Wales Hospital Clinical School, University of NSW, Randwick, Australia
| | - Amanda G Holford
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Betty S H Chan
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, Australia
- Faculty of Medicine, Prince of Wales Hospital Clinical School, University of NSW, Randwick, Australia
| | - Katherine Z Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Huber S, Avera R, Penfound S, Overberg A, Nañagas K. Safety of Physostigmine for Pediatric Antimuscarinic Poisoning. J Med Toxicol 2024:10.1007/s13181-024-00988-0. [PMID: 38265619 DOI: 10.1007/s13181-024-00988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Physostigmine fell out of widespread use in the 1980s due to safety concerns; however, more recent research has demonstrated that its safety profile is better than previously thought. These studies have mainly included adults. We theorized that improved safety data may lead to more acceptance. Our objectives, therefore, were to characterize current frequency of use of physostigmine in pediatric patients as well as to study adverse effect rates in a national pediatric patient population. METHODS The National Poison Data System was queried for cases of patients aged 0-18 years that involved single-substance exposures to antimuscarinic xenobiotics that were reported to a poison center between January 1, 2000, and December 31, 2020. Cases were stratified into groups by therapy received: benzodiazepines alone, benzodiazepines and physostigmine, physostigmine alone, or no physostigmine or benzodiazepines. Patient demographics, clinical effects, and medical outcomes were analyzed. RESULTS A total of 694,132 cases were reviewed, and 150,075 were included for analysis. Nearly 5% (7562/150,075) of patients received specific pharmacological therapy with benzodiazepines, physostigmine, or both. A benzodiazepine as a single agent was the most frequently used pharmacologic therapy (92% of 7562). Among patients receiving any pharmacological therapy, only 8.3% (n = 627) of patients received physostigmine. Frequency of serious outcomes significantly increased across the study period among patients receiving benzodiazepines alone or with physostigmine. There was no increase in serious outcomes among patients receiving only physostigmine. CONCLUSIONS Physostigmine frequency of use was low overall, but when used, was associated with less severe outcomes when compared to benzodiazepines.
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Affiliation(s)
- Sarah Huber
- Indiana University School of Medicine, Indianapolis, IN, USA
- IU Health Methodist Hospital, 1701 North Senate Blvd. B412b, Indianapolis, IN, 46234, USA
| | - Robert Avera
- Indiana University School of Medicine, Indianapolis, IN, USA
- IU Health Methodist Hospital, 1701 North Senate Blvd. B412b, Indianapolis, IN, 46234, USA
- Indiana University Health - Academic Health Center, Indianapolis, IN, USA
- Indiana Poison Center, Indianapolis, IN, USA
| | - Shannon Penfound
- IU Health Methodist Hospital, 1701 North Senate Blvd. B412b, Indianapolis, IN, 46234, USA
- Indiana Poison Center, Indianapolis, IN, USA
| | - Adam Overberg
- Indiana University School of Medicine, Indianapolis, IN, USA
- IU Health Methodist Hospital, 1701 North Senate Blvd. B412b, Indianapolis, IN, 46234, USA
- Indiana University Health - Academic Health Center, Indianapolis, IN, USA
- Indiana Poison Center, Indianapolis, IN, USA
| | - Kristine Nañagas
- Indiana University School of Medicine, Indianapolis, IN, USA.
- IU Health Methodist Hospital, 1701 North Senate Blvd. B412b, Indianapolis, IN, 46234, USA.
- Indiana University Health - Academic Health Center, Indianapolis, IN, USA.
- Indiana Poison Center, Indianapolis, IN, USA.
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Hölle T, Purrucker JC, Morath B, Weigand MA, Schmitt FCF. [Central anticholinergic, neuroleptic malignant and serotonin syndromes]. WIENER KLINISCHES MAGAZIN : BEILAGE ZUR WIENER KLINISCHEN WOCHENSCHRIFT 2023; 26:124-132. [PMID: 37251531 PMCID: PMC10123475 DOI: 10.1007/s00740-023-00492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Impaired consciousness is a frequent phenomenon after general anesthesia. In addition to the classical causes (e.g., overhang of sedatives), an impairment of consciousness can also be an adverse side effect of drugs. Many drugs used in anesthesia can trigger these symptoms. Alkaloids, such as atropine can trigger a central anticholinergic syndrome, opioids can promote the occurrence of serotonin syndrome and the administration of a neuroleptic can lead to neuroleptic malignant syndrome. These three syndromes are difficult to diagnose due to the individually very heterogeneous symptoms. Mutual symptoms, such as impaired consciousness, tachycardia, hypertension and fever further complicate the differentiation between the syndromes; however, more individual symptoms, such as sweating, muscle tension or bowl sounds can be helpful in distinguishing these syndromes. The time from the trigger event can also help to differentiate the syndromes. The central anticholinergic syndrome is the fastest to appear, usually taking just a few of hours from trigger to clinical signs, serotonin syndrome takes several hours up to 1 day to show and neuroleptic malignant syndrome usually takes days. The clinical symptoms can range from mild to life-threatening. Generally, mild cases are treated with discontinuation of the trigger and extended observation. More severe cases can require specific antidotes. The specific treatment recommended for central anticholinergic syndrome is physostigmine with an initial dose of 2 mg (0.04 mg/kg body weight, BW) administered over 5 min. For serotonin syndrome an initial dose of 12 mg cyproheptadine followed by 2 mg every 2 h is recommended (maximum 32 mg/day or 0.5 mg/kgBW day-1) but this medication is only available in Germany as an oral formulation. For neuroleptic malignant syndrome 25-120 mg dantrolene (1-2.5 mg/kgBW maximum 10 mg/kgBW day-1) is the recommended treatment.
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Affiliation(s)
- Tobias Hölle
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
| | - Jan C. Purrucker
- Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Benedict Morath
- Krankenhausapotheke, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Markus A. Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
| | - Felix C. F. Schmitt
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
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Koutsogiannis Z, Guertin M. Thirteen toxicology tidbits for the emergency clinician. Emerg Med Australas 2023; 35:336-338. [PMID: 36812916 DOI: 10.1111/1742-6723.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Zeff Koutsogiannis
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, Australia
| | - Marina Guertin
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
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Whitledge JD, Soto P, Glowacki KM, Fox ER, Mazer-Amirshahi M. Shortages of agents used to treat antimuscarinic delirium. Am J Emerg Med 2023; 67:163-167. [PMID: 36893630 DOI: 10.1016/j.ajem.2023.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Antimuscarinic delirium (AD), a potentially life-threatening condition frequently encountered by emergency physicians, results from poisoning with antimuscarinic agents. Treatment with physostigmine and benzodiazepines is the mainstay of pharmacotherapy, and use of dexmedetomidine and non-physostigmine centrally-acting acetylcholinesterase inhibitors (cAChEi) such as rivastigmine has also been described. Unfortunately, these medications are subject to drug shortages which negatively impact the ability to provide appropriate pharmacologic treatment of patients with AD. METHODS Drug shortage data were retrieved from the University of Utah Drug Information Service (UUDIS) database from January 2001 through December 2021. Shortages of first-line agents used to treat AD (physostigmine and parenteral benzodiazepines) and second-line agents (dexmedetomidine and non-physostigmine cAChEi) were examined. Drug class, formulation, route of administration, reason for shortage, shortage duration, generic status, and whether the drug was a single-source product (made by only one manufacturer) were extracted. Shortage overlap and median shortage durations were calculated. RESULTS Twenty-six shortages impacting drugs used to treat AD were reported to UUDIS from January 1, 2001 to December 31, 2021. Median shortage duration for all medication classes was 6.0 months. Four shortages were unresolved at the end of the study period. The single medication most often on shortage was dexmedetomidine, however benzodiazepines were the most common medication class on shortage. Twenty-five shortages involved parenteral formulations, and one shortage involved the transdermal patch formulation of rivastigmine. The majority (88.5%) of shortages involved generic medications, and 50% of products on shortage were single-source. The most common reported reason for shortage was a manufacturing issue (27%). Shortages were often prolonged and, in 92% of cases, overlapped temporally with other shortages. Shortage frequency and duration increased during the second half of the study period. CONCLUSION Shortages of agents used in the treatment of AD were common during the study period and affected all agent classes. Shortages were often prolonged and multiple shortages were ongoing at study period end. Multiple concurrent shortages involving different agents occurred, which could hamper substitution as a means of mitigating shortage. Healthcare stakeholders must develop innovative patient- and institution-specific solutions in times of shortage and work to build resilience into the medical product supply chain to minimize future shortages of drugs used for treatment of AD.
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Affiliation(s)
- James D Whitledge
- Harvard Medical Toxicology Fellowship, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215, USA.
| | - Pelayia Soto
- National Capital Poison Center, 3201 New Mexico Avenue, Suite 310, Washington, DC 20016, USA; Department of Emergency Medicine, The George Washington University School of Medicine, 230 Eye Street, NW, Washington, DC 20037, USA
| | - Kieran M Glowacki
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Erin R Fox
- Department of Pharmacy Services, University of Utah Health, 50 N. Medical Drive, A-050, Salt Lake City, UT 84132, USA
| | - Maryann Mazer-Amirshahi
- National Capital Poison Center, 3201 New Mexico Avenue, Suite 310, Washington, DC 20016, USA; Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA
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Hölle T, Purrucker JC, Morath B, Weigand MA, Schmitt FCF. [Central anticholinergic, neuroleptic malignant and serotonin syndromes : Important differential diagnoses in postoperative impairment of consciousness]. DIE ANAESTHESIOLOGIE 2023; 72:157-165. [PMID: 36799968 PMCID: PMC9936123 DOI: 10.1007/s00101-023-01256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 02/18/2023]
Abstract
Impaired consciousness is a frequent phenomenon after general anesthesia. In addition to the classical causes (e.g., overhang of sedatives), an impairment of consciousness can also be an adverse side effect of drugs. Many drugs used in anesthesia can trigger these symptoms. Alkaloids, such as atropine can trigger a central anticholinergic syndrome, opioids can promote the occurrence of serotonin syndrome and the administration of a neuroleptic can lead to neuroleptic malignant syndrome. These three syndromes are difficult to diagnose due to the individually very heterogeneous symptoms. Mutual symptoms, such as impaired consciousness, tachycardia, hypertension and fever further complicate the differentiation between the syndromes; however, more individual symptoms, such as sweating, muscle tension or bowl sounds can be helpful in distinguishing these syndromes. The time from the trigger event can also help to differentiate the syndromes. The central anticholinergic syndrome is the fastest to appear, usually taking just a few of hours from trigger to clinical signs, serotonin syndrome takes several hours up to 1 day to show and neuroleptic malignant syndrome usually takes days. The clinical symptoms can range from mild to life-threatening. Generally, mild cases are treated with discontinuation of the trigger and extended observation. More severe cases can require specific antidotes. The specific treatment recommended for central anticholinergic syndrome is physostigmine with an initial dose of 2 mg (0.04 mg/kg body weight, BW) administered over 5 min. For serotonin syndrome an initial dose of 12 mg cyproheptadine followed by 2 mg every 2 h is recommended (maximum 32 mg/day or 0.5 mg/kgBW day-1) but this medication is only available in Germany as an oral formulation. For neuroleptic malignant syndrome 25-120 mg dantrolene (1-2.5 mg/kgBW maximum 10 mg/kgBW day-1) is the recommended treatment.
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Affiliation(s)
- Tobias Hölle
- grid.5253.10000 0001 0328 4908Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
| | - Jan C. Purrucker
- grid.5253.10000 0001 0328 4908Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Benedict Morath
- grid.5253.10000 0001 0328 4908Krankenhausapotheke, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Markus A. Weigand
- grid.5253.10000 0001 0328 4908Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
| | - Felix C. F. Schmitt
- grid.5253.10000 0001 0328 4908Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
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Zhou H, Li H, Gowravaram N, Quan M, Kausar N, Gomperts SN. Disruption of hippocampal neuronal circuit function depends upon behavioral state in the APP/PS1 mouse model of Alzheimer's disease. Sci Rep 2022; 12:21022. [PMID: 36471155 PMCID: PMC9723144 DOI: 10.1038/s41598-022-25364-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The Alzheimer's disease-associated peptide amyloid-beta (Aβ) has been associated with neuronal hyperactivity under anesthesia, but clinical trials of anticonvulsants or neural system suppressors have, so far, failed to improve symptoms in AD. Using simultaneous hippocampal calcium imaging and electrophysiology in freely moving mice expressing human Aβ, here we show that Aβ aggregates perturbed neural systems in a state-dependent fashion, driving neuronal hyperactivity in exploratory behavior and slow wave sleep (SWS), yet suppressing activity in quiet wakefulness (QW) and REM sleep. In exploratory behavior and REM sleep, Aβ impaired hippocampal theta-gamma phase-amplitude coupling and altered neuronal synchronization with theta. In SWS, Aβ reduced cortical slow oscillation (SO) power, the coordination of hippocampal sharp wave-ripples with both the SO and thalamocortical spindles, and the coordination of calcium transients with the sharp wave-ripple. Physostigmine improved Aβ-associated hyperactivity in exploratory behavior and hypoactivity in QW and expanded the range of gamma that coupled with theta phase, but exacerbated hypoactivity in exploratory behavior. Together, these findings show that the effects of Aβ alone on hippocampal circuit function are profoundly state dependent and suggest a reformulation of therapeutic strategies aimed at Aβ induced hyperexcitability.
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Affiliation(s)
- Heng Zhou
- grid.32224.350000 0004 0386 9924MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA USA ,grid.417303.20000 0000 9927 0537Jiangsu Key Laboratory of Brain Disease and Bioinformation, Research Center for Biochemistry and Molecular Biology, Xuzhou Medical University, Xuzhou, China
| | - Hanyan Li
- grid.32224.350000 0004 0386 9924MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA USA
| | - Niket Gowravaram
- grid.32224.350000 0004 0386 9924MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA USA
| | - Moqin Quan
- grid.32224.350000 0004 0386 9924MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA USA
| | - Naila Kausar
- grid.32224.350000 0004 0386 9924MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA USA
| | - Stephen N. Gomperts
- grid.32224.350000 0004 0386 9924MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA USA
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Stanton MT. Part
II
: Interactive case: Toxicology and poison control. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Khoshnam‐Rad N, Heydari M, Mohammadi K, Mashayekhi M, Sahraei Z, Gholami K. Datura poisoning in a family: Case series and literature review. Clin Case Rep 2022; 10:e6091. [PMID: 35903511 PMCID: PMC9314559 DOI: 10.1002/ccr3.6091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/11/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Datura spp. is a potentially poisonous plant that is widely spread and is simply accessible, which can yield poisoning with a central and peripheral anticholinergic effect. We reported cases of family poisoning caused by the herbal tea with refreshing effects that were identified as Datura spp. Datura spp. and many other complementary medicine products are potentially poisonous or could cause adverse effects or interact with prescribed medications. The herbal medicine business is not well regulated and has the potential to cause significant harm. Physicians must routinely gain a history of the use of herbal products.
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Affiliation(s)
- Niloofar Khoshnam‐Rad
- Department of Clinical Pharmacy, Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran
| | - Marziyeh Heydari
- Department of Clinical Pharmacy, Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran
| | - Keyhan Mohammadi
- Department of Clinical Pharmacy, Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran
| | - Mojgan Mashayekhi
- Drug and Poison Information Center Tehran University of Medical Sciences Tehran Iran
| | - Zahra Sahraei
- Department of Clinical Pharmacy School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran
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Natural Products from Plants and Algae for Treatment of Alzheimer’s Disease: A Review. Biomolecules 2022; 12:biom12050694. [PMID: 35625622 PMCID: PMC9139049 DOI: 10.3390/biom12050694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/14/2022] Open
Abstract
Neurodegenerative disorders including Parkinson’s disease (PD), Huntington’s disease (HD) and the most frequent, Alzheimer’s disease (AD), represent one of the most urgent medical needs worldwide. Despite a significantly developed understanding of disease development and pathology, treatments that stop AD progression are not yet available. The recent approval of sodium oligomannate (GV-971) for AD treatment in China emphasized the potential value of natural products for the treatment of neurodegenerative disorders. Many current clinical studies include the administration of a natural compound as a single and combination treatment. The most prominent mechanisms of action are anti-inflammatory and anti-oxidative activities, thus preserving cellular survival. Here, we review current natural products that are either approved or are in testing for a treatment of neurodegeneration in AD. In addition to the most important compounds of plant origin, we also put special emphasis on compounds from algae, given their neuroprotective activity and their underlying mechanisms of neuroprotection.
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Bertol E, Vaiano F, Argo A, Zerbo S, Trignano C, Protani S, Favretto D. Overdose of Quetiapine-A Case Report with QT Prolongation. TOXICS 2021; 9:toxics9120339. [PMID: 34941773 PMCID: PMC8703483 DOI: 10.3390/toxics9120339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022]
Abstract
Quetiapine is an atypical antipsychotic drug used to treat bipolar disorder, schizophrenia, and major depressive disorder. Although several studies describe the adverse effects of intoxication with Quetiapine, only a few report an extreme overdose without comedications that lead to a life threat. We present a case of a 75-year-old male who tried to attempt suicide by ingesting 28 g of Quetiapine. During the management in the emergency department, both serum and urine samples were collected, allowing a complete pharmacokinetic analysis to be conducted, from the admission to the discharge.
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Affiliation(s)
- Elisabetta Bertol
- Research Unit U.R.I.To.N., University of Firenze, 50134 Firenze, Italy;
| | - Fabio Vaiano
- Forensic Toxicology Division, Department of Health Sciences, University of Firenze, 50134 Firenze, Italy;
| | - Antonina Argo
- Department of Health Promotion, Maternal Child Care and Medical Specialties, University of Palermo, 90151 Palermo, Italy; (A.A.); (S.Z.)
| | - Stefania Zerbo
- Department of Health Promotion, Maternal Child Care and Medical Specialties, University of Palermo, 90151 Palermo, Italy; (A.A.); (S.Z.)
| | - Claudia Trignano
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Simone Protani
- School of Specialization of Legal Medicine, University Hospital of Padova, Via Falloppio 50, 35121 Padova, Italy;
| | - Donata Favretto
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio 50, 35121 Padova, Italy
- Correspondence:
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Arbabi A, Bao X, Shalaby WS, Razeghinejad R. Systemic side effects of glaucoma medications. Clin Exp Optom 2021; 105:157-165. [PMID: 34402741 DOI: 10.1080/08164622.2021.1964331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Glaucoma is a progressive loss of retinal ganglion cells leading to visual field loss. Lowering intraocular pressure is currently the only modifiable risk factor to slow glaucoma progression. Intraocular pressure-lowering options include topical and systemic medications, lasers, and surgical procedures. Glaucoma eye drops play a major role in treating this blinding disease. Similar to all medications, the glaucoma medications have their own adverse effects. The majority of glaucoma medications work by stimulating or inhibiting adrenergic, cholinergic, and prostaglandin receptors, which are distributed all over the body. Therefore, the glaucoma medications can affect organs other than the eye. This review will discuss the systemic adverse effects of carbonic anhydrase inhibitors, sympathomimetics, para-sympathomimetics, beta blockers, prostaglandin analogs, hyperosmotic agents, and novel glaucoma medications with a stress on pregnant patients, breastfeeding mothers, and paediatric patients.
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Affiliation(s)
- Amirmohsen Arbabi
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Xuan Bao
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Wesam Shamseldin Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Mohan S, Backus T, Furlano E, Howland MA, Smith SW, Su MK. A Case of Massive Diphenhydramine and Naproxen Overdose. J Emerg Med 2021; 61:259-264. [PMID: 34148773 DOI: 10.1016/j.jemermed.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diphenhydramine, a first generation H1 histamine receptor antagonist, is a commonly used nonprescription medication that is used for the treatment of allergy, as a sleep aid, or combined with cough and cold remedies. Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is used commonly for analgesia. Although most cases of diphenhydramine or naproxen overdose require excellent supportive care only, meticulous attention should be given to cardiovascular and neurologic status. CASE REPORT A 22-year-old woman presented with altered mental status secondary to intentional ingestion of 240 combination caplets of naproxen sodium 220 mg and diphenhydramine hydrochloride 25 mg. While in the emergency department, she manifested a wide-complex tachycardia in the setting of hypotension that required repeated administration of sodium bicarbonate to overcome the sodium channel blockade caused by diphenhydramine. Aggressive potassium repletion was performed simultaneously. Her clinical course was complicated by status-epilepticus that required intubation. Orogastric lavage was performed, which returned blue pill slurry consistent with the ingested caplets. The patient was extubated on hospital day 2 and transferred to psychiatry thereafter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In light of recent social media trends, such as the "Benadryl challenge" and its widespread availability, emergency providers should be familiar with diphenhydramine toxicity, especially the life-threatening neurologic consequences and risk of cardiovascular collapse. NSAIDs, such as naproxen, and other nonprescription analgesics are becoming more and more important in light of the current opioid crisis. There should be an emphasis on understanding these medications and their potential implications when taken in overdose.
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Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Timothy Backus
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Emma Furlano
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Mary Ann Howland
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; St. John's University College of Pharmacy and Health Sciences, Jamaica, New York
| | - Silas W Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York University Langone Health, New York, New York
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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Naughton SX, Beck WD, Wei Z, Wu G, Baas PW, Terry AV. The Carbamate, Physostigmine does not Impair Axonal Transport in Rat Cortical Neurons. Neurosci Insights 2021; 16:26331055211020289. [PMID: 34104889 PMCID: PMC8155748 DOI: 10.1177/26331055211020289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022] Open
Abstract
Among the various chemicals that are commonly used as pesticides,
organophosphates (OPs), and to a lesser extent, carbamates, are most frequently
associated with adverse long-term neurological consequences. OPs and the
carbamate, pyridostigmine, used as a prophylactic drug against potential nerve
agent attacks, have also been implicated in Gulf War Illness (GWI), which is
often characterized by chronic neurological symptoms. While most OP- and
carbamate-based pesticides, and pyridostigmine are relatively potent
acetylcholinesterase inhibitors (AChEIs), this toxicological mechanism is
inadequate to explain their long-term health effects, especially when no signs
of acute cholinergic toxicity are exhibited. Our previous work suggests that a
potential mechanism of the long-term neurological deficits associated with OPs
is impairment of axonal transport (AXT); however, we had not previously
evaluated carbamates for this effect. Here we thus evaluated the carbamate,
physostigmine (PHY), a highly potent AChEI, on AXT using an in
vitro neuronal live imaging assay that we have previously found to
be very sensitive to OP-related deficits in AXT. We first evaluated the OP,
diisopropylfluorophosphate (DFP) (concentration range 0.001-10.0 µM) as a
reference compound that we found previously to impair AXT and subsequently
evaluated PHY (concentration range 0.01-100 nM). As expected, DFP impaired AXT
in a concentration-dependent manner, replicating our previously published
results. In contrast, none of the concentrations of PHY (including
concentrations well above the threshold for impairing AChE) impaired AXT. These
data suggest that the long-term neurological deficits associated with some
carbamates are not likely due to acute impairments of AXT.
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Affiliation(s)
- Sean X Naughton
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Wayne D Beck
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Zhe Wei
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Guangyu Wu
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Peter W Baas
- Department of Neurobiology and Anatomy, Drexel University, College of Medicine, Philadelphia, PA, USA
| | - Alvin V Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Evaluation and Management of Toxicological Causes of Delirium. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00230-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Iqubal A, Rahman SO, Ahmed M, Bansal P, Haider MR, Iqubal MK, Najmi AK, Pottoo FH, Haque SE. Current Quest in Natural Bioactive Compounds for Alzheimer's Disease: Multi-Targeted-Designed-Ligand Based Approach with Preclinical and Clinical Based Evidence. Curr Drug Targets 2021; 22:685-720. [PMID: 33302832 DOI: 10.2174/1389450121999201209201004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 12/06/2022]
Abstract
Alzheimer's disease is a common and most chronic neurological disorder (NDs) associated with cognitive dysfunction. Pathologically, Alzheimer's disease (AD) is characterized by the presence of β-amyloid (Aβ) plaques, hyper-phosphorylated tau proteins, and neurofibrillary tangles, however, persistence oxidative-nitrative stress, endoplasmic reticulum stress, mitochondrial dysfunction, inflammatory cytokines, pro-apoptotic proteins along with altered neurotransmitters level are common etiological attributes in its pathogenesis. Rivastigmine, memantine, galantamine, and donepezil are FDA approved drugs for symptomatic management of AD, whereas tacrine has been withdrawn because of hepatotoxic profile. These approved drugs only exert symptomatic relief and exhibit poor patient compliance. In the current scenario, the number of published evidence shows the neuroprotective potential of naturally occurring bioactive molecules via their antioxidant, anti-inflammatory, antiapoptotic and neurotransmitter modulatory properties. Despite their potent therapeutic implications, concerns have arisen in context to their efficacy and probable clinical outcome. Thus, to overcome these glitches, many heterocyclic and cyclic hydrocarbon compounds inspired by natural sources have been synthesized and showed improved therapeutic activity. Computational studies (molecular docking) have been used to predict the binding affinity of these natural bioactive as well as synthetic compounds derived from natural sources for the acetylcholine esterase, α/β secretase Nuclear Factor kappa- light-chain-enhancer of activated B cells (NF-kB), Nuclear factor erythroid 2-related factor 2(Nrf2) and other neurological targets. Thus, in this review, we have discussed the molecular etiology of AD, focused on the pharmacotherapeutics of natural products, chemical and pharmacological aspects and multi-targeted designed ligands (MTDLs) of synthetic and semisynthetic molecules derived from the natural sources along with some important on-going clinical trials.
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Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Syed Obaidur Rahman
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Musheer Ahmed
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Pratichi Bansal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Md Rafi Haider
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Abul Kalam Najmi
- Department of Pharmacology, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal, University, P.O.BOX 1982, Damman, 31441, Saudi Arabia
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, JamiaHamdard, New Delhi-110062, India
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Halder N, Lal G. Cholinergic System and Its Therapeutic Importance in Inflammation and Autoimmunity. Front Immunol 2021; 12:660342. [PMID: 33936095 PMCID: PMC8082108 DOI: 10.3389/fimmu.2021.660342] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022] Open
Abstract
Neurological and immunological signals constitute an extensive regulatory network in our body that maintains physiology and homeostasis. The cholinergic system plays a significant role in neuroimmune communication, transmitting information regarding the peripheral immune status to the central nervous system (CNS) and vice versa. The cholinergic system includes the neurotransmitter\ molecule, acetylcholine (ACh), cholinergic receptors (AChRs), choline acetyltransferase (ChAT) enzyme, and acetylcholinesterase (AChE) enzyme. These molecules are involved in regulating immune response and playing a crucial role in maintaining homeostasis. Most innate and adaptive immune cells respond to neuronal inputs by releasing or expressing these molecules on their surfaces. Dysregulation of this neuroimmune communication may lead to several inflammatory and autoimmune diseases. Several agonists, antagonists, and inhibitors have been developed to target the cholinergic system to control inflammation in different tissues. This review discusses how various molecules of the neuronal and non-neuronal cholinergic system (NNCS) interact with the immune cells. What are the agonists and antagonists that alter the cholinergic system, and how are these molecules modulate inflammation and immunity. Understanding the various functions of pharmacological molecules could help in designing better strategies to control inflammation and autoimmunity.
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Affiliation(s)
- Namrita Halder
- Laboratory of Autoimmunity and Tolerance, National Centre for Cell Science, Ganeshkhind, Pune, India
| | - Girdhari Lal
- Laboratory of Autoimmunity and Tolerance, National Centre for Cell Science, Ganeshkhind, Pune, India
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18
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Plaetinck I, Heerman J, Van De Velde S, Allaert S, Kalmar A. Anticholinergic symptoms in a patient with a bupropion overdose successfully managed with physostigmine: a case report. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of anticholinergic poisoning in a patient suffering from an overdose of bupropion. The patient presented with bilateral mydriasis, involuntary movements and signs of agitation. Bupropion is commonly used as antidepressant and smoking cessation aid. It inhibits neuronal reuptake of dopamine and norepinephrine and also antagonizes acetylcholine at the level of the nicotinic receptor sites. So far bupropion overdose resulting in symptoms mimicking an anticholinergic syndrome has rarely been reported in literature.
In this case, one milligram of intravenous physostigmine, an acetylcholinesterase inhibitor, rapidly resolved patient agitation and mydriasis. This case indicates that physostigmine might be used as an antidote to quickly reverse the central and peripheral anticholinergic symptoms in patients with an overdose of bupropion.
Erratum
This article is the corrected version of the article published in issue 2020/3, pages 137-140. Typos and order of authors have now been corrected. With apologies to the authors.
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19
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Wang GS, Baker K, Ng P, Janis GC, Leonard J, Mistry RD, Heard K. A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome. Clin Toxicol (Phila) 2020; 59:698-704. [DOI: 10.1080/15563650.2020.1854281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
| | - Keith Baker
- Departments of Emergency Medicine and Medical Toxicology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Patrick Ng
- En route Care Research Center, Lackland AFB, San Antonio, TX, USA
| | - Gregory C. Janis
- MedTox Laboratories, Laboratory Corporation of America Holdings, Saint Paul, MN, USA
| | - Jan Leonard
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
| | - Rakesh D. Mistry
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
| | - Kennon Heard
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, CO, USA
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20
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Blackstone NG, Olson A, Ainapurapu B. Physostigmine in Anticholinergic Poisoning: An Old Antidote With Resurgence. Cureus 2020; 12:e11739. [PMID: 33403170 PMCID: PMC7773307 DOI: 10.7759/cureus.11739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Physostigmine is a cholinesterase inhibitor used therapeutically in patients with anticholinergic delirium that is so severe that intubation may be required for airway protection. Given that a wide variety of medications have anticholinergic properties, and the current standard of care is typically a central nervous system depressant, hospitalizations are often lengthy and normally require a critical-care level of attention. Despite this, physostigmine is often underutilized and poorly understood in the clinical setting. We report a case of a 43-year-old female who presented to the emergency department one hour after ingesting approximately 150 tablets of diphenhydramine in a suicide attempt. She was treated with benzodiazepines with minimal success, and airway protection became imminent as her mentation continued to decline. Through the use of physostigmine, we were able to save this patient from endotracheal intubation and the potential complications of mechanical ventilation.
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Affiliation(s)
| | - April Olson
- Internal Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | - Bujji Ainapurapu
- Internal Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
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21
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Van Kernebeek MW, Ghesquiere M, Vanderbruggen N, Verhoeven E, Hubloue I, Crunelle CL. Rivastigmine for the treatment of anticholinergic delirium following severe procyclidine intoxication. Clin Toxicol (Phila) 2020; 59:447-448. [PMID: 32960128 DOI: 10.1080/15563650.2020.1818768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M W Van Kernebeek
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - M Ghesquiere
- Department of Emergency Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - N Vanderbruggen
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - E Verhoeven
- Department of Emergency Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - I Hubloue
- Department of Emergency Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - C L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Toxicological Center, Antwerp University, Antwerp, Belgium
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22
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Kalmar A, Plaetinck I, Heerman J, Van De Velde S, Allaert S. Anticholinergic symptoms in a patient with a bupropion overdose successfully managed with physostigmine: a case report. ACTA ANAESTHESIOLOGICA BELGICA 2020. [DOI: 10.56126/71.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of anticholinergic poisoning in a patient suffering from an overdose of bupropion. The patient presented with bilateral mydriasis, involuntary movements and signs of agitation. Bupropion is commonly used as antidepressant and smoking cessation aid. It inhibits neuronal reuptake of dopamine and norepinephrine and also antagonizes acetylcholine at the level of the nicotinic receptor sites. So far bupropion overdose resulting in symptoms mimicking an anticholinergic syndrome has rarely been reported in literature.
In this case, one milligram of intravenous physostigmine, an acetylcholinesterase inhibitor, rapidly resolved patient agitation and mydriasis. This case indicates that physostigmine might be used as an antidote to quickly reverse the central and peripheral anticholinergic symptoms in patients with an overdose of bupropion.
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23
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Dembitsky VM, Dzhemileva L, Gloriozova T, D'yakonov V. Natural and synthetic drugs used for the treatment of the dementia. Biochem Biophys Res Commun 2020; 524:772-783. [PMID: 32037088 DOI: 10.1016/j.bbrc.2020.01.123] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 01/07/2023]
Abstract
This review is devoted to comparative pharmacological analysis of synthetic drugs such as memantine and its isomers, as well as tacrine, velnacrine, rivastigmine, and donepezil, with natural alkaloids, terpenoids, and triterpenoid peroxides, which are used to treat dementia, Alzheimer's and Parkinson's diseases, myasthenia gravis and other neurodegenerative diseases. Recently discovered by French scientists from Marseille triterpenoid hydroperoxides demonstrate high activity as potential therapeutic agents for the treatment of dementia. The information presented in this review is of great interest to pharmacologists, medical chemists, physiologists, neurologists and doctors, as well as for the pharmaceutical industry.
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Affiliation(s)
- Valery M Dembitsky
- Centre for Applied Research, Innovation and Entrepreneurship, Lethbridge College, 3000 College Drive South, Lethbridge, AB T1K 1L6, Canada.
| | - Lilya Dzhemileva
- Institute of Petrochemistry and Catalysis, Russian Academy of Sciences, Ufa, 450075, Russia.
| | - Tatyana Gloriozova
- Institute of Biomedical Chemistry, Russian Academy of Sciences, Moscow, 119121, Russia.
| | - Vladimir D'yakonov
- Institute of Petrochemistry and Catalysis, Russian Academy of Sciences, Ufa, 450075, Russia.
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24
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Tschirdewahn J, Eyer F. [Diagnostics and treatment of selected clinically relevant, acute drug intoxications]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1313-1323. [PMID: 31578621 DOI: 10.1007/s00103-019-03024-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute drug poisoning due to accidental or self-damaging overdoses is responsible for 5-10% of emergency medical interventions in Germany. The treatment of asymptomatic to life-threatening courses requires extensive expertise. On the basis of a selective literature search, this article gives an overview of selected clinically relevant, acute drug poisonings with regard to epidemiology, symptomatology, diagnostics, and therapy.Intoxications with psychotropic drugs are the most common drug intoxications. Poisoning with tricyclic antidepressants causes anticholinergic, central nervous, and cardiovascular symptoms. Less toxic are selective serotonin reuptake inhibitors (SSRIs); the intoxication may be characterized by serotonin syndrome. Malignant neuroleptic syndrome is a severe complication of neuroleptic poisoning.Poisoning with analgesics is clinically relevant due to its high availability. For paracetamol poisoning, intravenous acetylcysteine is available as an antidote. Hemodialysis may be indicated for severe salicylate intoxication. Poisoning with nonsteroidal anti-inflammatory drugs is usually only associated with mild signs of intoxication.Poisoning with cardiac drugs (β-blockers and calcium antagonists) can cause life-threatening cardiovascular events. In addition to symptomatic therapy, insulin glucose therapy also plays an important role.The majority of acute drug poisonings can be treated adequately by symptomatic and partly intensive care therapy - if necessary with the application of primary and secondary toxin elimination. Depending on the severity of the intoxication, pharmacology-specific therapy must be initiated.
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Affiliation(s)
- Julia Tschirdewahn
- Abteilung für Klinische Toxikologie & Giftnotruf München, Universitätsklinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Florian Eyer
- Abteilung für Klinische Toxikologie & Giftnotruf München, Universitätsklinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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