Lipid Emulsion as Rescue Therapy in Lamotrigine Overdose

Castanares-Zapatero, Diego; Wittebole, Xavier; Huberlant, Vincent; Morunglav, Mihaiela; Hantson, Philippe

doi:10.1016/j.jemermed.2010.11.055

Cited by 45 publications

(38 citation statements)

References 12 publications

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“…In the anticonvulsant group, there were three cases of lamotrigine, which has been reported to have sodium channel-blocking effects [57,58]. There was only one case of VT/VF associated with valproic acid overdose and no cases of TdP; previous case reports suggest that valproate may cause QTc prolongation, possibly due to hypocalcemia [59,60].…”

Section: Discussionmentioning

confidence: 95%

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Al-Abri

Woodburn

Olson

et al. 2015

Am J Cardiovasc Drugs

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Key PointsThe most commonly involved therapeutic classes of drugs associated with ventricular fibrillation and/or tachycardia (VT/VF) were antidepressants (25 %) and stimulants (25 %).The drugs most commonly associated with torsade de pointes (TdP) were antidepressants (25 %) and methadone (25 %).Drug exposures with the greatest risk of death in association with VT/VF were antidepressant exposure [odds ratio (OR) 1.71] and antiarrhythmic exposure (OR 1.75), but neither association was statistically significant.

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Section: Discussionmentioning

confidence: 95%

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Al-Abri

Woodburn

Olson

et al. 2015

Am J Cardiovasc Drugs

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“…Since then, use in local anesthetic systemic toxicity, and more recently use in toxidromes from drugs other than local anesthetics, has been increasingly reported [18][19][20][21][22][23]. Systematic reporting of outcomes following ILE infusion for such indications has been lacking with only single case reports, and short case series [27] appearing in literature to date.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical use of ILE in non-local anesthetic poisoning has similarly been associated with successful resuscitation outcome in numerous case reports of overdose with pharmacologically disparate agents [18][19][20][21][22][23]. However, given the variability of drugs taken in overdose and the range of both generic and specific antidotes utilized to treat cardiovascular toxicity in concert with administered ILE therapy in these cases, the magnitude of any benefit attributable to ILE administration remains unclear [24].…”

Section: Introductionmentioning

confidence: 99%

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

et al. 2014

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The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients' presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirtyeight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p<0.0001) and increased systolic blood pressure (p=0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.

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“…Animal studies have established benefit from ILE in various models of toxicity including verapamil [5,6], propranolol [7], amiodarone [8], and clomipramine [9]. Case studies have demonstrated successful use of ILE in haloperidol induced cardiac arrest [10], lamotrigine overdose [11], and in resuscitations of patients with combination ingestions of quetiapine/sertraline [12] and buproprion/lamotrigine [13].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Alters the Hemodynamic Response to Epinephrine in a Rat Model

et al. 2013

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Intravenous lipid emulsion (ILE) is an adjunctive antidote used in selected critically ill poisoned patients. These patients may also require administration of advanced cardiac life support (ACLS) drugs. Limited data is available to describe interactions of ILE with standard ACLS drugs, specifically epinephrine. Twenty rats with intra-arterial and intravenous access were sedated with isoflurane and split into ILE or normal saline (NS) pretreatment groups. All received epinephrine 15 μm/kg intravenously (IV). Continuous mean arterial pressure (MAP) and heart rate (HR) were monitored until both indices returned to baseline. Standardized t tests were used to compare peak MAP, time to peak MAP, maximum change in HR, time to maximum change in HR, and time to return to baseline MAP/HR. There was a significant difference (p=0.023) in time to peak MAP in the ILE group (54 s, 95 % CI 44-64) versus the NS group (40 s, 95 % CI 32-48) and a significant difference (p=0.004) in time to return to baseline MAP in ILE group (171 s, 95 % CI 148-194) versus NS group (130 s, 95 % CI 113-147). There were no significant differences in the peak change in MAP, peak change in HR, time to minimum HR, or time to return to baseline HR between groups. ILE-pretreated rats had a significant difference in MAP response to epinephrine; ILE delayed the peak effect and prolonged the duration of effect of epinephrine on MAP, but did not alter the peak increase in MAP or the HR response.

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Lipid Emulsion as Rescue Therapy in Lamotrigine Overdose

Cited by 45 publications

References 12 publications

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

Intravenous Lipid Emulsion Alters the Hemodynamic Response to Epinephrine in a Rat Model

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