Promethazine and Treatment Refractory Agitation in Clonidine Toxicity
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 3 No. 3(Summer) (2013),
6 September 2013
Background:Delirium is an acute and transient turmoil disorder in consciousness which is often caused by drugs.One of the adverse effects of clonidine is agitation. Clonidine is an agonist of α2-receptor which functionally overlaps with μ-receptor of opioids. Promethazine is H1-receptor antagonist and has antipsychotic properties. The necessary dose for initial control of agitation is 25-50 milligrams.
Case Presentation: A 27 year old man has been sent to emergency department following consumption of clonazepam 1 milligram, clonidine 0.1 milligram and alprazolam 0.5 milligram. Upon arrival at the toxicity emergency of the hospital, the patient's pulse rate suddenly dropped to 20 per min along with widening of QRS and increase of QTc as well as severe agitation. At the end of the second day due to continuous bradycardia pace maker was devised. The patient showed hallucination. In the third day, the patient's delirium increased. Due to no control of agitation by benzodiazepine, haloperidol, Promethazine 25 milligram was injected then slept after 5 minute.
Conclusion:In such patient with above restrictions, prescription of promethazine not only maintained blood pressure and caused no disorder in electrocardiogram, but also it immediately and certainly controlled patient's agitation.
- Promethazine. Agitation
How to Cite
Stern T,Celano C. The Assessment and Management of Agitation and Delirium in the General Hospital. Prim Care Companion J Clin Psychiatry. 2010;12(1)
Keith H, Carson H. Deadly Ingestions. PediatrClin N Am. 2006;53(1):293– 315.
Siegel M. Management of agitation in the intensive care unit. Clin Chest Med. 2003;24(3):713–725 .
Jamadarkhana S,Gopal SH. Clonidine in Adults as a Sedative Agent in the Intensive Care Unit. J AnaesthesiolClinPharmacol. 2010;26(4):439–445.
Schiveled J,Staal M. Refractory agitation as a marker for pediatric delirium in very young infants at a pediatric intensive care unit. Intensive Care Med. 2010;36(11):1982–1983.
eHealthMe - Real World Drug Outcomes. http://WWW.ehealthMe.com
VishneT.Amiaz R. Promethazine for the treatment of agitation after electroconvulsive therapy: a case series. JECT. 2005;21(2):118-21.
Raveendran N. Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. BMJ. 2007;335(7625):865-870.
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