Treatment of comatose patient from cyclobenzaprine overdose with therapeutic plasma exchange

Buyukgoz, Cihangir; Gangu, Shantaveer; Gowani, Faaria; Kimura, Dai

doi:10.1002/jca.21960

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Hucker et al ( 1 ) showed that peak plasma levels in dogs are reached after 2 h when given a 2 mg/kg dose orally or intravenously. Cyclobenzaprine is 93% protein-bound ( 9 , 11 , 17 ), is widely distributed to the tissues ( 14 , 17 ), and undergoes enterohepatic recirculation ( 12 – 14 ). It is extensively metabolized in the liver by cytochrome P450, 1A2, and 3A4 ( 9 , 11 , 13 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…While some metabolites are excreted in the feces ( 1 ), the majority are excreted via the kidneys as a glucuronide ( 1 , 9 , 13 , 14 ). The elimination half-life is approximately 18 h but can range between 8 and 37 h ( 13 , 14 , 17 ). The LD50 is 338 and 425 mg/kg in mice and rats, respectively ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…Activated charcoal may be administered to help reduce enterohepatic recirculation ( 7 ). In one case study of a severely affected human, total plasmapheresis was successfully performed to decrease time to clinical resolution ( 17 ). Sodium bicarbonate has been used in humans with QRS prolongation ( 13 ), and physostigmine has been used in cases of anticholinergic signs refractory to supportive care ( 8 , 11 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Case report: Treatment of cyclobenzaprine ingestion in two dogs with intravenous intralipid therapy

Dreese,

Odunayo,

Bucknoff

2024

Front. Vet. Sci.

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IntroductionThe objective of this case series is to describe the clinical signs and outcome of cyclobenzaprine ingestion in two dogs treated with intralipid emulsion (ILE) and supportive care.Case or series summaryTwo dogs presented for evaluation of cyclobenzaprine ingestion. A 4-year-old female spayed Rat Terrier (dog 1) presented within 4 h of ingestion of cyclobenzaprine (between 9.7 and 25.9 mg/kg). The dog experienced abnormal behavior, agitation, tremors, tachycardia, and hypertension. There were no significant clinicopathological abnormalities. The dog was treated with ILE, cyproheptadine, and activated charcoal. All clinical signs resolved after treatment. A 5-month-old female intact mixed-breed dog (dog 2) presented after ingestion of an unknown amount of cyclobenzaprine 2–3 h prior to presentation. The dog experienced dull mentation, tremors, loss of gag reflex, tachycardia, and hypertension. There were no significant clinicopathological abnormalities. Orogastric decontamination was performed via gastric lavage, and activated charcoal was given via orogastric tube, followed by ILE. All clinical signs resolved after therapeutic intervention.DiscussionThis is the first report documenting clinical signs of cyclobenzaprine toxicity in two dogs followed by successful treatment with gastric emptying, ILE, and supportive care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case report: Treatment of cyclobenzaprine ingestion in two dogs with intravenous intralipid therapy

Dreese,

Odunayo,

Bucknoff

2024

Front. Vet. Sci.

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Effect of plasmapheresis on drug pharmacokinetics in children: a structured review of the current literature

Yaghyazaryan,

Gracchi,

le Poole

et al. 2024

Intensive Care Med. Paediatr. Neonatal

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Introduction In this structured review, we present a structured overview on the effect of plasmapheresis on pharmacokinetics (PK) of drugs in children. Furthermore, we intended to analyse if, based on the changed PK, evidence-based drug dosing regimens for drugs at therapeutic dosages in this population have been developed. Methods A structured literature search assessing drug PK/exposure in children undergoing plasmapheresis was conducted in EMBASE and PubMed on 23 March 2023. Studies were labelled as relevant when data on PK/exposure after plasmapheresis in patients younger than 18 years-old was reported. Extracted parameters included patient characteristics, plasmapheresis related characteristics and PK/exposure related parameters. Results Twenty-six studies were identified, 96% being case reports. PK/exposure data for eighteen drugs in children undergoing plasmapheresis were included, 69% of the studies reported significant change in drug exposure after plasmapheresis. In 38% of the studies plasmapheresis was used in combination with drugs at therapeutic dosages, with no significant drug removal. No evidence-based drug dosing regimen for drugs at therapeutic dosages in children undergoing plasmapheresis have been developed. However, the usefulness of plasmapheresis in drug poisoning has been demonstrated, in case reports, for 31% of the overdosages. Conclusions This structured review shows that a very limited number of studies have been performed on the PK/exposure of drugs in children undergoing plasmapheresis. Furthermore, it became clear that predicting the risk of drug removal by plasmapheresis based on theoretical (drug properties or PK) criteria for adults is not always applicable to children.

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Cardiovascular Manifestations After Amitriptyline Poisoning in the Last Five Years

Pereira,

Picanço,

De Oliveira

et al. 2024

Rev. Contemp.

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Tricyclic antidepressants (TCAs) were introduced in the 1950s for the treatment of depression. In adults, TCAs are used to treat depression, migraine headache prophylaxis, neuralgic pain, including pain associated with cigarette poisoning, and obsessive-compulsive disorder. Despite the current limited use of ADT, hospitalizations and deaths associated with ADT use are increasing. Therefore, this work sought to verify the profile of amitriptyline poisoning in the last five years through articles downloaded from the Web of Science database - all databases - between the years 2019 and 2023. According to the results, TCA toxicity can mainly induce cardiovascular manifestations, leading to respiratory depression, sinus tachycardia, or even more dangerous tachydysrhythmias and even bradycardia with or without heart block. These findings indicate that TCA toxicity can be fatal, and this information is of great importance to facilitate understanding and appropriate management by health professionals involved in the care of patients with depression and other diseases that require the use of amitriptyline.

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Treatment of comatose patient from cyclobenzaprine overdose with therapeutic plasma exchange

Cited by 3 publications

References 8 publications

Case report: Treatment of cyclobenzaprine ingestion in two dogs with intravenous intralipid therapy

Case report: Treatment of cyclobenzaprine ingestion in two dogs with intravenous intralipid therapy

Effect of plasmapheresis on drug pharmacokinetics in children: a structured review of the current literature

Cardiovascular Manifestations After Amitriptyline Poisoning in the Last Five Years

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