Cyclizine Toxicity — Intentional Drug Abuse of a Proprietary Antihistamine

Gott, Peter H.

doi:10.1056/nejm196809122791109

Cited by 21 publications

(4 citation statements)

References 3 publications

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“…Occasionally, stimulatory effects such as insomnia, hyperreflexia, irritability, excitement, headaches, muscle twitching, nervousness, tremor, dyskinesia, dystonia and seizures may occur (Bailie et al 1987;Davis 1976;Favis 1976;Gott 1968;King & Weeks 1965;Krenzelok et al 1982;Lavenstein & Cantor 1976;Lee et al 1975;Lewith & Davidson 1981;Magera et al 1981 ;McMahon 1986;Thach Drug Safety 10 (5) 1994Wyngaarden & Seevers 1951). Neuropsychiatric effects such as anxiety, confusion, impaired mental efficiency, impairment judgement, depression, delusions, hallucinations and even psychoses have been reported (Baehr et al 1986;Berger et al 1977;Borman 1947;Dollberg et al 1989;Gott 1968;Jones et al 1986;Leighton 1982;Nigro 1968;Richmond & Seger 1986;Roman 1972;Sachs 1948;Schipior 1967). Peripheral nervous system adverse effects such as areflexia, paralysis, paraesthesias, and toxic neuritis have also been noted (Douglas 1980;Meltzer 1990;Wyngaarden & Seevers 1951).…”

Section: Assessment and Management Of H I-antagonist Overdosementioning

confidence: 99%

H1-Receptor Antagonists

1994

Drug Safety

196

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Section: Assessment and Management Of H I-antagonist Overdosementioning

confidence: 99%

H1-Receptor Antagonists

1994

Drug Safety

196

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“…Overdoses of second‐generation antihistamines are rarely leading to severe toxicity . The abuse potential has been discussed in relation to OTC medicines in general and has been observed and reported for first‐generation antihistamines such as promethazine and cyclizine, for example for a calming effect, enhancement of other co‐ingested substances or for recreational use leading to hallucinogenic experiences .…”

mentioning

confidence: 99%

A Danish Survey of Antihistamine Use and Poisoning Patterns

Jensen

Rømsing

Dalhoff

2016

Basic Clin Pharma Tox

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The first-generation antihistamine, promethazine, became a prescription-only drug in Denmark as of December 2014. First-generation antihistamines are known to have a higher toxic potential than second-generation antihistamines. The aim of this study was to provide a nationwide description of the antihistamine use and poisoning pattern from 2007 to 2013 in Denmark based on two independent databases. There were 1049 antihistamine exposures in the national, advisory telephone service specialized in poisonings, the Danish Poison and Information Centre (DPIC), and 456 exposures in the three registers used within the State Serum Institute of Denmark (SSI), a department under the Danish Ministry of Health dealing with research-based health surveillance in Denmark. First-generation antihistamines constitute 61% and 73% of antihistamine registrations in DPIC and SSI, respectively. Antihistamine exposures increased by 7 exposures/10,000 enquiries per year in DPIC and six admissions per year in SSI -this increase is not significant due to a sudden decrease in 2012. Intentional exposures constituted 65% in DPIC of which 82% was due to suicide attempts, and 78% of the involved antihistamines were first-generation antihistamines. Accidental exposures constituted 33% of which 61% were due to play and 29% involved first-generation antihistamines. Single antihistamine exposures constituted 65% of DPIC exposures of which 98% involved only one brand of antihistamine. Multidrug exposures constituted 35% of DPIC exposures with equally distributed coingestants. Hospitalization was recommended in 78% of DPIC exposures. Admissions required only 1-day of treatment in 91% of the SSI exposures. One of the 14 identified deaths in the SSI study population was directly related to antihistamine poisoning. Results support the limited disclosure of promethazine in Denmark and illustrate a generation-specific pattern indicating a suspected replacement of promethazine with other firstgeneration antihistamines.

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“…concurrent use of alcohol, the principal side-effect, which is sometimes deliberately sought by young drug takers, is visual hallucinosis (Gott, 1968). concurrent use of alcohol, the principal side-effect, which is sometimes deliberately sought by young drug takers, is visual hallucinosis (Gott, 1968).…”

Section: Antihistaminesmentioning

confidence: 99%

Adverse Psychiatric Reactions to Modern Medication

Whitlock

1981

Aust N Z J Psychiatry

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From this survey it will be apparent that many psychiatric reactions to drugs are largely caused by their direct toxic actions or from combinations of drugs. As such, they are often dose related, although age and slow speed of detoxification will increase the risk of patients developing delirium, hallucinations, sleep disturbances, anxiety etc. Similar toxic reactions can also occur when drugs to which a patient has developed some measure of tolerance are abruptly withdrawn. In this context the effects of drugs upon patterns of sleep may be important determinants of adverse withdrawal symptoms. In contrast are the reactions which resemble one or other of the functional psychoses. In these patients it appears that a past history of an affective or schizophrenic psychosis is the best predictor of a similar illness being precipitated by a particular drug. Nonetheless, with substances like reserpine and cycloserine there is good reason for thinking that, given a sufficient quantity, practically any patient can develop an adverse psychiatric reaction.

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Cyclizine Toxicity — Intentional Drug Abuse of a Proprietary Antihistamine

Cited by 21 publications

References 3 publications

H1-Receptor Antagonists

H1-Receptor Antagonists

A Danish Survey of Antihistamine Use and Poisoning Patterns

Adverse Psychiatric Reactions to Modern Medication

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