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Milella MS, Petraccia L, Pirelli F, Foti G, Sapio M, Berardi R, Caprioli D, Pugliese F, Vivino G. Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022. Pharmacoepidemiol Drug Saf 2024; 33:e5767. [PMID: 38357800 DOI: 10.1002/pds.5767] [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: 06/08/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. METHODS Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. RESULTS A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. CONCLUSION Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.
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Affiliation(s)
- Michele Stanislaw Milella
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Francesca Pirelli
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Foti
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Maria Sapio
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Rosaria Berardi
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Daniele Caprioli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Gabriella Vivino
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
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Ősz BE, Jîtcă G, Sălcudean A, Rusz CM, Vari CE. Benzydamine-An Affordable Over-the-Counter Drug with Psychoactive Properties-From Chemical Structure to Possible Pharmacological Properties. Pharmaceuticals (Basel) 2023; 16:ph16040566. [PMID: 37111323 PMCID: PMC10144213 DOI: 10.3390/ph16040566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Benzydamine is a non-steroidal anti-inflammatory drug with distinct pharmacological properties from other compounds in the same therapeutic class. The differences are structural and pharmacological in nature; the anti-inflammatory mechanism is not strictly explained by the ability to interfere with the synthesis of prostaglandins. The compound is used strictly in local inflammatory diseases (inflammation in the oral and vaginal mucosa). In addition to the therapeutic indications found in the summary of product characteristics (SPC), the compound is used, in high doses, as a psychotropic substance for oral administration, having similar properties to lysergic acid diethylamide (LSD). As an over-the-counter (OTC) compound, it is easy to obtain, and the consequences of using it for purposes other than those assumed by the manufacturer raise various concerns. The reasons are related to the pharmacodynamic and pharmaco-toxicological properties, since neither the mechanism of action nor the possible side effects that would result from systemic consumption, in high doses, even occasionally, have been fully elucidated. The present review aims to analyze the pharmacodynamic properties of benzydamine, starting from the chemical structure, by comparison with structurally similar compounds registered in therapy (as an anti-inflammatory or analgesic) or used for recreational purposes.
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Affiliation(s)
- Bianca-Eugenia Ősz
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - George Jîtcă
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Andreea Sălcudean
- Department of Ethics and Social Sciences, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Carmen Maria Rusz
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Camil-Eugen Vari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Mi X, Cui B, Song J, Zhang J. Visible-Light-Promoted Direct C3-H Cyanomethylation of 2 H-Indazoles. ACS OMEGA 2023; 8:11192-11200. [PMID: 37008106 PMCID: PMC10061648 DOI: 10.1021/acsomega.2c08094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 06/19/2023]
Abstract
The efficient visible-light-promoted cyanomethylation of 2H-indazoles in the presence of Ir(ppy)3 as the photocatalyst and bromoacetonitrile as the cyanomethyl radical source was achieved under mild conditions, providing a series of C3-cyanomethylated derivatives in good yields.
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Liu Y, Tong Z, Shi J, Jia Y, Deng T, Wang Z. Reversion of antibiotic resistance in multidrug-resistant pathogens using non-antibiotic pharmaceutical benzydamine. Commun Biol 2021; 4:1328. [PMID: 34824393 PMCID: PMC8616900 DOI: 10.1038/s42003-021-02854-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance has been a growing concern that gradually undermines our tradition treatment regimens. The fact that few antibacterial drugs with new scaffolds or targets have been approved in the past two decades aggravates this crisis. Repurposing drugs as potent antibiotic adjuvants offers a cost-effective strategy to mitigate the development of resistance and tackle the increasing infections by multidrug-resistant (MDR) bacteria. Herein, we found that benzydamine, a widely used non-steroidal anti-inflammatory drug in clinic, remarkably potentiated broad-spectrum antibiotic-tetracyclines activity against a panel of clinically important pathogens, including MRSA, VRE, MCRPEC and tet(X)-positive Gram-negative bacteria. Mechanistic studies showed that benzydamine dissipated membrane potential (▵Ψ) in both Gram-positive and Gram-negative bacteria, which in turn upregulated the transmembrane proton gradient (▵pH) and promoted the uptake of tetracyclines. Additionally, benzydamine exacerbated the oxidative stress by triggering the production of ROS and suppressing GAD system-mediated oxidative defensive. This mode of action explains the great bactericidal activity of the doxycycline-benzydamine combination against different metabolic states of bacteria involve persister cells. As a proof-of-concept, the in vivo efficacy of this drug combination was evidenced in multiple animal infection models. These findings indicate that benzydamine is a potential tetracyclines adjuvant to address life-threatening infections by MDR bacteria.
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Affiliation(s)
- Yuan Liu
- College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China. .,Institute of Comparative Medicine, Yangzhou University, Yangzhou, 225009, China. .,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, 225009, China. .,Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, 225009, China.
| | - Ziwen Tong
- College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China
| | - Jingru Shi
- College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China
| | - Yuqian Jia
- College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China
| | - Tian Deng
- College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China
| | - Zhiqiang Wang
- College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, China. .,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, 225009, China. .,Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, 225009, China.
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Stefania C, Andrea M, Alessio M, Mauro P, Amira G, Martin CJ, Giovanni M, Massimo DG, Fabrizio S. The Benzydamine Experience: A Systematic Review of Benzydamine Abuse. Curr Neuropharmacol 2021; 19:1728-1737. [PMID: 33441070 PMCID: PMC8977632 DOI: 10.2174/1570159x19666210113151136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Both prescription and over-the-counter (OTC) drugs recently emerged among novel psychoactive substances (NPS) being reported as ingested for recreational purposes. Among them, benzydamine (BZY), normally prescribed as an OTC anti-inflammatory drug, is reportedly being diverted and recreationally used. OBJECTIVE The aim of this study was to investigate how the misuse of BZY has been reported, illustrating its psychotropic molecular mechanism, and studying its psychopathological effects. METHODS We firstly conducted a systematic review of the literature concerning the abuse of BZY and its effects. For data gathering purposes, both PRISMA and PROSPERO guidelines were followed. All research methods were approved by PROSPERO (identification code CRD42020187266). Second, we analysed BZY-related data from the European Monitoring Agency (EMA) Adverse Drug Reactions (ADRs) database recorded during 2005-2020 regarding its abuse. RESULTS Eleven articles, published during 1997-2019, were included in our systematic review, including five case reports, four surveys, and two retrospective case series analyses. While nine articles dealt with the recreational use of BZY, two described an oral overdose of the drug. When specified, dosages of BZY consumed ranged from 500 to 1500mg. The EMA dataset contained three cases of BZY abuse. CONCLUSION Results from the systematic review showed BZY might be diverted for typical hallucinogenic properties occurring at high dosages. Healthcare professionals should be warned about a possible misuse/abuse of a commonly prescribed anti-inflammatory drug and be vigilant when prescribing it. Physicians working in emergency units should know that psychotic symptoms may be related to BZY abuse.
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Affiliation(s)
- Chiappini Stefania
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Miuli Andrea
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Italy
| | - Mosca Alessio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Italy
| | - Pettorruso Mauro
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Italy
| | - Guirguis Amira
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Corkery John Martin
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Martinotti Giovanni
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Italy
| | - Di Giannantonio Massimo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, Italy
| | - Schifano Fabrizio
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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Ghosh S, Mondal S, Hajra A. Direct Catalytic Functionalization of Indazole Derivatives. Adv Synth Catal 2020. [DOI: 10.1002/adsc.202000423] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sumit Ghosh
- Department of Chemistry Visva-Bharati (A Central University) Santiniketan 731235 India
| | - Susmita Mondal
- Department of Chemistry Visva-Bharati (A Central University) Santiniketan 731235 India
| | - Alakananda Hajra
- Department of Chemistry Visva-Bharati (A Central University) Santiniketan 731235 India
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Gürü M, Şafak Y, Cengiz GF, Kuru E, Örsel S. Chronic psychosis related to benzydamine hydrochloride abuse. Neurocase 2019; 25:156-158. [PMID: 31088213 DOI: 10.1080/13554794.2019.1617318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Benzydamine hydrochloride is a non-steroidal anti-inflammatory drug with analgesic and antipyretic effects. In those who use medicines containing this agent at high doses (500-3000 mg), some adverse effects such as hallucinosis, stimulant effects in the central nervous system, paranoia, and convulsions can be seen. The drug is vulnerable to abuse because of the stimulant effects on the central nervous system. In this paper, we present a young male patient with symptoms of psychosis due to benzydamine hydrochloride abuse. He was admitted to the psychiatry outpatient clinic with visual hallucinations, fear, and insomnia. His symptoms started after taking 10 tablets of benzydamine hydrochloride (500 mg) 6 months ago, which continued for 1-2 days and spontaneously resolved. The patient used high doses of the drug 3-4 times over a period of 3 months. Although his last drug intake was 3 months ago, his symptoms continued at the time of admission to the clinic. A neurologic examination and detailed laboratory tests of the patient revealed no evidence of a cause for psychotic symptoms. The patient was scheduled to undergo oral antipsychotic therapy. Although similar cases have been reported in the literature, this is the only case in which psychosis was still present despite discontinuation of the drug. Our aim was to contribute to the literature on the use of BH in causing chronic psychosis and to draw attention to the growing number of BH abuse cases.
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Affiliation(s)
- Meltem Gürü
- a Department of Psychiatry , Gazi Universitesi , Ankara , Turkey
| | - Yasir Şafak
- b Department of Psychiatry , Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi , Ankara , Turkey
| | - Gül Ferda Cengiz
- c Department of Psychiatry , Bozok Universitesi , Yozgat , Turkey
| | - Erkan Kuru
- d Department of Psychiatry , Özel Boylam Psikiyatri Hastanesi , Ankara , Turkey
| | - Sibel Örsel
- b Department of Psychiatry , Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi , Ankara , Turkey
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