Resin Haemoperfusion in Levomepromazine Poisoning: Evaluation of Effect on Plasma Drug and Metabolite Levels

Abstract

<jats:p> 1 Plasma levels of levomepromazine and two of its major metabolites N-desmethyl-levomepromazine and levomepromazine sulphoxide were studied in two poisoned patients treated with resin haemoperfusion at a constant blood flow of 200 ml/min. </jats:p><jats:p> 2 The mean haemoperfusion clearance of levomepromazine, N-desmethyl-levomepromazine and levomepromazine sulphoxide was 114, 123 and 151 ml/min, respectively, in patient no. 1, and 153, 148 and 184 ml/min, respectively, in patient no. 2. Patient no. 2 had also ingested amitriptyline, and the mean haemoperfusion clearance of amitriptyline and its metabolite nortriptyline was 183 and 183 ml/min respectively. </jats:p><jats:p> 3 Haemoperfusion did not seem to alter the elimination profile of levomepromazine or the two metabolites in either patient. </jats:p><jats:p> 4 We conclude that haemoperfusion is of little value in removing levomepromazine, N-desmethyl-levomepromazine or levomepromazine sulphoxide from the body. This is probably due to the large apparent volume of distribution and the high intrinsic hepatic metabolic clearance of these compounds. </jats:p>

Extracorporeal Treatment for Tricyclic Antidepressant Poisoning: Recommendations from the EXTRIP Workgroup

“…Furthermore, the application of ECTRs, even if they are usually considered generally safe, is not without cost and risks. In the present literature review, adverse effects of ECTRs, other than death, were reported: in subjects undergoing hemoperfusion, thrombocytopenia was reported in 25 patients, anemia in 12, bleeding or coagulation problems in 2, a clotting cartridge in 1, hypotension in 2, hypocalcemia in 5, and pulmonary edema in 1 . Peritoneal dialysis‐related peritonitis was reported in one patient, hyperglycemia in three cases, and hypothermia in one .…”

“…From the initial 1312 studies obtained, 77 studies met the inclusion criteria, including 1 observational study , 5 animal studies , 4 in vitro studies , 4 pharmacokinetic (PK) studies , and 63 case reports , 39 of which had sufficient toxicokinetic (TK) data. In total, 108 patients were included for analysis.…”