Acute zolpidem poisoning--analysis of 344 cases.

Zolpidem is a new short acting hypnotic agent, first launched in France in 1988. Three hundred forty-four cases of intentional acute overdoses are reviewed retrospectively. Patients were predominantly female (70%) in their third or fourth decade. Ingested doses of zolpidem ranged between 10 and 1400 mg (one pack or less in 80%). Half of the patients ingested other substances (psychotropic drugs and alcohol) concomitantly. Signs of intoxication were observed in two thirds of the population but could be attributed to zolpidem in only 105 cases: drowsiness (N = 89) occurred at doses of 140 to 440 mg; coma (N = 4) or respiratory failure (N = 1). Other symptoms were rare (excepted vomiting, N = 7). Of the rare electrocardiographic or biological abnormalities, none appeared to be directly related to zolpidem. Therapy for intoxication was usually limited to supportive measures and/or gastric lavage. Symptoms of intoxication rapidly remitted in 91% of cases. Three percent of patients with multiple drug ingestion recovered despite severe complications during intensive care. Fatalities were reported for 6% but could not be directly linked to zolpidem. Previous published reports are confirmed: zolpidem acute overdose is generally benign and requires no specific therapeutic measures.

Acute fluvoxamine poisoning.

A total of 221 cases of deliberate acute overdose with fluvoxamine reported to the Paris Poison Centre, and 78 cases collected by the International Drug Safety Department of Duphar BV were analysed. Other agents, mainly benzodiazepines, neuroleptics, other antidepressants and alcohol, were also taken in 77% of the cases. The acute toxicity that could be attributed to fluvoxamine alone was rarely severe. The symptoms observed were always benign when the dose of fluvoxamine was below 1000 mg and included drowsiness, tremor, nausea, vomiting, abdominal pain, bradycardia and/or anticholinergic effects (dry mouth, mydriasis, sinus tachycardia, urinary retention). Seizures occurred in a few cases after high doses (generally > 1500 mg). Cardiotoxicity was not a serious problem; sinus bradycardia was noted with doses of less than 1000 mg, but was always moderate and required no treatment. Conduction abnormalities were rare.

[Acute poisoning by scilliroside]. / Intoxication aiguë par le scilliroside.

A 43-year-old man, with no history of cardiac disease, deliberately ingested 4 tablets of a rodenticide containing 12 mg of scilliroside. Vomiting appeared a few minutes later and persisted for 48 hours. At the 20th hour, when he was admitted, EKG revealed a complete atrio-ventricular block which disappeared only on the 4th day. The repolarization abnormalities characteristic of digitalization persisted still further until the 12th day.

[Acute toloxatone poisoning. Apropos of 122 cases]. / Intoxication aiguë par la toloxatone. A propos de 122 observations.

Toloxatone is a new monoamine oxidase inhibitor. One hundred and twenty two cases of poisoning with this drug are reported. In this series, the minimal toxic dose was 2 g. The first symptoms appeared about one hour after ingestion. In most cases, only drowsiness and mild adrenergic effects were observed. In a few cases of massive overdose, coma, pyramidal irritation, and myoclonic jerks occurred. In 3 cases of severe poisoning, toloxatone was associated with tricyclic antidepressants. Symptoms were similar to those reported in intoxications associating classical monoamine oxidase inhibitors and tricyclic antidepressants: muscular rigidity, hyperthermia and cardiovascular collapse. Two of these patients died.