Disulfiramlike Toxin Toxicity Medication
- Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to neutralize effects of the toxin.
GI decontaminant
Class Summary
These agents are empirically used to minimize systemic adsorption of the toxin.
Activated charcoal (Actidose-Aqua, Insta-Char, Liqui-Char)
Most useful if administered within 4 h of ingestion. Repeat doses may be used, especially with ingestion of sustained release agents. Limited outcome studies exist, especially when administration is more than 1 h after ingestion.
Administration of charcoal by itself (in aqueous solution), as opposed to coadministration with a cathartic, is becoming the current practice standard because no studies have shown benefit from cathartics and, while most drugs and toxins are adsorbed within 30-90 min, laxatives take hours to work. Dangerous fluid and electrolyte shifts have occurred when cathartics are used in small children.
When ingested dose is known, charcoal may be given at 10 times ingested dose of agent over 1 or 2 doses.
Antiemetics
Class Summary
These agents are used to control nausea and vomiting.
Metoclopramide (Reglan)
Prokinetic agent that increases GI motility and accelerates gastric emptying. Works as antiemetic by blocking dopamine receptors in chemoreceptor trigger zone of CNS.
Prochlorperazine (Compazine)
May relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing reticular activating system.
In addition to antiemetic effects, it has the advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.
H2-receptor antagonists
Class Summary
H2-receptor antagonists are reversible competitive blockers of histamine at the H2 receptors, particularly those in the gastric parietal cells where they inhibit acid secretion. The H2-receptor antagonists are highly selective, do not affect the H1 receptors, and are not anticholinergic agents.
Ranitidine (Zantac)
H2-receptor antagonist that may be a useful adjunct in reducing emesis volume.
Antiemetic, Serotonin Antagonist
Class Summary
These agents are used to treat vomiting and symptomatic nausea resulting from radiation therapy and/or chemotherapy, for postoperative nausea and vomiting, and for general symptomatic relief.
Ondansetron (Zofran)
Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Indicated for nausea and vomiting due to radiation and/or chemotherapy, for postoperative nausea and vomiting, and for general symptomatic relief. While historically an expensive medication, recent availability of a generic form has removed cost as a consideration.
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