Plant Poisoning: Quinolizidine and Isoquinoline Medication

Updated: Mar 07, 2022
  • Author: David Vearrier, MD, MPH; Chief Editor: Asim Tarabar, MD  more...
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Medication Summary

The goals of pharmacotherapy are to reduce toxicity, reduce morbidity, and prevent complications. Activated charcoal is the treatment of choice for all quinoline and/or isoquinoline plant ingestions. It is the most effective substance known for adsorbing most poisons. Ipecac syrup administered as a precursor to charcoal is no longer recommended.

Benzodiazepines can be used for patients who experience seizures. Opiate antagonists can be used to reverse opiate toxidrome.


Antidotes, Other

Class Summary

Gastrointestinal (GI) decontamination with oral activated charcoal is selectively used in the emergency treatment of poisoning caused by some drugs and chemicals. The network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Consider decontamination with activated charcoal in symptomatic patients or patients with substantial ingestions who present within 1 hour after the ingestion.

Activated charcoal (Actidose-Aqua, EZ-Char, Kerr Insta-Char)

Activated charcoal prevents absorption of toxic alkaloids by adsorbing them in the intestine. Activated charcoal does not dissolve in water. For maximum effect, administer this agent within 30 minutes after ingestion.


Anticonvulsants, Other

Class Summary

Benzodiazepines are agents of choice for cytisine-induced or other alkaloid-induced seizures.

Lorazepam (Ativan)

Lorazepam is beneficial for its sedative and anticonvulsant effects.

Diazepam (Valium, Diastat, Diastat AcuDial, Diastat Pediatric)

Diazepam is beneficial for its sedative and anticonvulsant effects. This agent has a relatively long half-life. It may be given intramuscularly if intravenous access is not available.


Opioid Reversal Agents

Class Summary

These agents are used in patients with altered mental status and opiate toxidrome, which can result from ingestion of poppy seeds.


Naloxone prevents or reverses opioid effects (eg, hypotension, respiratory depression, sedation), possibly by displacing opiates from their receptors.