Mushroom Toxicity Medication
- Author: Rania Habal, MD; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM more...
Medication Summary
The goals of pharmacotherapy are to neutralize the toxin, to reduce morbidity, and to prevent complications.
Anticonvulsants
Class Summary
These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.
Lorazepam (Ativan)
Sedative hypnotic with short onset of effects and relatively long half-life.
By increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, it may depress all levels of CNS, including limbic and reticular formation.
Monitor patient's blood pressure after administering dose. Adjust as necessary.
Diazepam (Valium)
Depresses all levels of CNS (eg, limbic, reticular formation), possibly by increasing activity of GABA.
Phenobarbital (Barbita, Luminal)
Interferes with transmission of impulses from thalamus to cortex of brain.
Antiemetics
Class Summary
These agents block the dopamine receptors in the chemoreceptor trigger zone.
Prochlorperazine (Compazine)
May relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing reticular activating system.
Not recommended in children < 20 lb due to high incidence of extrapyramidal effects.
Metoclopramide (Reglan)
Works as antiemetic by blocking dopamine receptors in the chemoreceptor trigger zone of the CNS.
GI decontaminants
Class Summary
These agents are empirically used to minimize systemic absorption of the toxin.
Activated charcoal (Liqui-Char)
Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal absorbs 100-1000 mg of drug per g of charcoal. Does not dissolve in water. For maximum effect, administer within 30 min after ingesting poison. The first dose of activated charcoal generally is used with a cathartic (eg, sorbitol 1 g/kg PO). Additional doses of sorbitol are not administered to children due to resultant excessive intraintestinal osmotic shifts, electrolyte imbalance, and intravascular volume depletion.
Polyethylene glycol (GoLYTELY)
Laxative with strong electrolyte and osmotic effects that has cathartic actions in GI tract.
Antidotes
Class Summary
Most amatoxin antidotes are experimental and based on animal studies and/or anecdotal reports of success in humans.
Penicillin G (Pfizerpen)
Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. Blocks amanitin uptake by hepatocytes and prevents amanitin from binding to RNA polymerase.
Silibinin (Silibinin Plus)
Compound made of silymarin, an extract of the milk thistle plant Silybum marianum. May act as a free radical scavenger or may interrupt enterohepatic circulation. Blocks amanitin uptake by hepatocytes. Available in Europe but not the United States.
N-acetylcysteine (Mucosil, Mucomyst)
May provide substrate for conjugation with toxic metabolite.
Pyridoxine (Nestrex)
May be used in conjunction with benzodiazepines for the treatment of convulsions that develop with gyromitrin toxicity. Involved in synthesis of GABA within the CNS.
Methylene blue (Urolene Blue)
In reduced form, leukomethylene blue is an electron donor to reduce methemoglobin. Reduction of methylene blue is by NADPH generated by G-6-PD.
The FDA warns against the concurrent use of methylene blue with serotonergic psychiatric drugs, unless indicated for life-threatening or urgent conditions. Methylene blue may increase serotonin CNS levels as a result of MAO-A inhibition, increasing the risk of serotonin syndrome.[6]
Fomepizole (Antizol)
Anticortinarius antidote with better safety profile than ethanol. Easier to dose and administer. In contrast to ethanol, 4-MP levels do not need to be monitored during therapy.
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