Letter to the Editor: Protective Effect of Medication Bezoar After a Massive Beta-Blocker, Digoxin, and Amitriptyline Poisoning

Endoscopic removal of slow release clomipramine bezoars in two cases of acute poisoning

“…Other medications reported to be visible on abdominal x-ray or computed tomography include sustained release preparations of chlorpromazine, lithium, potassium chloride and salicylates, as well as iron with or without SR (5,6). Conglomerations of medications other than these may also be visible on x-ray (10). A plain abdominal x-ray or CT scan can only indicate the presence of a pharmacobezoar, however, and can not exclude it (6).…”

“…The recommendations in the literature concerning the optimal treatment of patients with pharmacobezoars are limited, variable, and inconclusive (1)(2)(3)(4)(5)(6)8,10). As these cases are rare, there are no clinical studies to rely on.…”

“…Other medications reported to occasionally form bezoars include amitriptyline, potassium chloride in sustained release (SR) preparations, SR procainamide, SR nifedipine, SR carbamazepine, SR meprobamate, SR iron, and also verapamil and theophylline with or without SR, and enteric-coated aspirin (2,(5)(6)(7)(8)10). Besides overdose, risk factors for the formation of pharmacobezoars include dehydration, alterations in the GI anatomy, diseases or disorders causing dysmotility of the Endoscopic removal of clomipramine bezoars 319 GI tract, and certain co-ingested medications, e.g., anticholinergic drugs and opiates (5).…”

Venlafaxine Pharmacobezoar Causing Intestinal Ischemia Requiring Emergent Hemicolectomy

“…For example, nifedipine SR products consist of an insoluble cellulose acetate shell that is excreted whole [5]. Finally, massive tablet ingestions, regardless of formulation, have caused pharmacobezoars [6, 7]. …”

“…However, since activated charcoal itself is unabsorbable, MDAC risks exacerbation of an existing pharmacobezoar or creation of a new one [2]. Another option, WBI has been utilized with inconsistent success to hasten passage or disruption of a pharmacobezoar [7–8]. If initiated early after a massive ingestion, WBI may prevent bezoar formation altogether.…”