Medication Summary
The goals of pharmacotherapy are to neutralize the effects of the toxic agent, to reduce morbidity, and to prevent complications.
Benzodiazepines
Class Summary
Lorazepam and diazepam, in particular, are the DOCs for hallucinogen ingestion. Anxiolytic and sedating properties calm agitated patients and help blunt coexisting hypertension and tachycardia.
Lorazepam (Ativan)
Sedative hypnotic with short onset of effects and relatively long half-life. Increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. When patients need to be sedated for longer than a 24-h period, this medication is excellent.
Diazepam (Valium)
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Neuroleptics
Class Summary
For severe agitation and/or psychosis. May decrease seizure threshold.
Haloperidol (Haldol)
Butyrophenone noted for high potency and low potential for causing orthostasis. Downside is high potential for EPS/dystonia.
Antidotes
Class Summary
Basic approach to treat patients with altered mental status includes administration of dextrose (or demonstration of normal blood glucose level), thiamine, and naloxone.
Dextrose (D-glucose)
Monosaccharide absorbed from the intestine and then distributed, stored, and used by the tissues.
Thiamine (Thiamilate)
To correct thiamine deficiency.
Naloxone (Narcan)
Prevents or reverses opioid effects (hypotension, respiratory depression, sedation), possibly by displacing opiates from their receptors.
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