20 years old femal taken 50 tablet of Flupentixol, she is now in coma , unconsciousness, how i can decrese the effect or eleminate these drug from body ?the toxicity happen from 3- 6 houres befor
This is what I was able to find with research:
Flupenthixol appears to be relatively safe in overdose.
A series of 28 overdoses followed up by NPIS London (Crome et
al, 1978) failed to show any serious toxicity.
Since flupenthixol is fairly slowly absorbed from the gut,
with tmax = 3 to 6 hours (Jorgensen, 1980; Jorgensen et al.,
1982), initial management of acute overdose should be aimed
primarily at prevention of absorption.
The major symptoms seen in acute overdose are likely to be
CNS depression, with the possibility of respiratory
depression (NPIS London, data on file), especially if alcohol
has also been taken. Extrapyramidal effects are also probable
(Mann, 1976; Bailie et al., 1981).
There is a danger of shock and hypotension in significant
overdose. However, flupenthixol does not cause the
cardiotoxic effects seen after overdosage with other
neuroleptics such as thioridazine, chlorpromazine and
haloperidol (Niemann et al., 1981; Lumpkin et al., 1979); nor
does it cause the anticholinergic effects associated with
tricyclic antidepressants (Mann, 1976).
Further treatment should therefore be basically supportive,
with particular attention to maintaining adequate ventilation
and blood pressure. Antiparkinsonian drugs should be given as
Methods of active removal, such as haemodialysis or
haemoperfusion, are unlikely to be of use, since flupenthixol
is highly protein-bound and has a large volume of
distribution (Jorgensen, 1980).
CNS and respiratory depression
Normal supportive management of the unconscious patient.
Measure arterial blood gases (pO2, pH) and/or respiratory
rate; intubate and ventilate if necessary.
Although flupenthixol itself does not cause acute
cardiotoxicity, patients who overdose on it frequently also
have access to cardiotoxic drugs such as tricyclic
antidepressants. If this is suspected, monitor ECG.
For hypotension, give intravenous fluids or plasma expanders
initially. This may be all that is required to restore
adequate blood pressure.
If hypotension is unresponsive to intravenous fluids, give
alphamimetic agents such as dopamine.
For agitation, hallucinations or convulsions give diazepam
Neuroleptic Malignant Syndrome
If NMS suspected, monitor temperature, arterial blood gases
(pO2, pH), serum electrolytes, glucose and CPK.
Cooling measures should be instituted, e.g. diazepam 0.1
mg/kg may be sufficient in mild hyperthermia (Smego & Durack,
1982). If severe (>40°C), dantrolene 1 to 10 mg/kg may be
effective, as it relieves muscle rigidity in malignant
hyperthermia (Cameron & Borthwick, 1983). Treat
extrapyramidal effects conventionally. Give procyclidine 5
to 10 mg intravenously, repeated as necessary (maximum dose
in 24 hours 20 mg), or benztropine 2 mg intravenously or
intramuscularly stat. Orphenadrine 20 mg intramuscularly
stat was also effective in a child (Bailie et al., 1981).
Because of the risk of secondary renal damage due to
rhabdomyolysis, adequate fluid balance should be maintained.
Consider alkalizing urine. Haemodialysis may be required in
renal failure (Tomson, 1986).
If extrapyramidal signs are mild (e.g. neck stiffness only),
and are not causing the patient distress, diazepam 0.05 to
0.1 mg/kg may suffice.
For more severe symptoms, give procyclidine 5 to 10 mg
intravenously, repeated as necessary (maximum dose in 24
hours 20 mg), or benztropine 2 mg (adults) intravenously or
intramuscularly stat. Orphenadrine 20 mg intramuscularly stat
was also effective in a child (Bailie et al., 1981).
Diphenhydramine 2 mg/kg (maximum 50 mg) intravenously stat
relieves symptoms rapidly, but may cause further sedation and
should be given with caution in drowsy patients.
Smaller doses of all these agents may be required in mixed
overdose with tricyclic antidepressants, due to the
possibility of anticholinergic symptoms.
After initial control of the acute dystonic reaction, oral
antiparkinsonian therapy should continue for 48 to 72 hours
to prevent recurrence of symptoms due to the long half-life
of flupenthixol. This may be given on an outpatient basis
(Corre et al., 1984). Suitable oral dosages are benztropine
1 to 2 mg twice daily, or diphenhydramine 50 mg three times
Tardive dyskinesia has only been seen in long-term
neuroleptic therapy. It is therefore unlikely to be seen in
acute overdose, or with oral therapy.
No truly effective treatment for tardive dyskinesia has yet
been established (Dick & Saunders, 1981). Current
recommendations consist of cessation of the drug and
symptomatic management of side- effects. Withdrawal of
flupenthixol is likely to lead initially to worsening of the
symptoms, though these tends to improve after some months.
Diltiazem in doses up to 360 mg/day may be effective in
relieving tardive dyskinesia, but requires further
investigation (Ross et al., 1987).
The efficacy of activated charcoal in flupenthixol overdose
has not been established, but it is probably useful since it
is effective with phenothiazines.
Give activated charcoal (50 g in adults, 1 to 2 mg/kg in
children) for any amount taken in a child and for more than
10 mg in an adult.
Due to possible enterohepatic recycling, repeated-dose
activated charcoal may be useful in large overdoses
(Jorgensen et al., 1969).
Emesis and gastric lavage
Gastric lavage should only be considered in rare cases
following recent ingestion of life-threatening amounts in
Do not give emetic because of potential for flupenthixol-
induced coma which may result in the loss of ability to
protect airway, causing aspiration pneumonitis.
Active methods of elimination (forced diuresis,
haemoperfusion, haemodialysis, alteration of urinary pH) are
ineffective due to flupenthixol's large volume of
distribution, and a high degree of protein binding
In patients with neuroleptic malignant syndrome,
haemodialysis or peritoneal dialysis may be required for
renal failure (Tomson, 1986).
10.6 Antidote treatment
10.7 Management discussion
11. ILLUSTRATIVE CASES
11.1 Case reports from literature
(Note: There are very few cases of flupenthixol
overdose reported in the literature, and those tend to be
anecdotal. Other reports of overdose are available from NPIS
London's case files).
Flupenthixol 18 to 20 mg (0.9 mg/kg) in a 3´- year-old girl
caused drowsiness after 90 minutes, progressing to Grade III
coma after 3 hours. Gastric lavage was performed, without
result (following attempted emesis with salt water).
Consciousness improved over the next 20 hours without further
At 23 hours post-ingestion she started suffering a series of
episodes of extrapyramidal effects, which persisted for over
10 hours. These initially included neck extension and
catalepsy; then festinating gait and facial and body
rigidity; and finally (at 33 hours) dysphagia and salivation,
treated with orphenadrine 20 mg. Recovery was complete by 48
hours (Bailie et al., 1981).
An adult patient (age and weight not stated) took 90 mg
flupenthixol and suffered only mild extrapyramidal signs
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