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Physostigmine for gamma-hydroxybutyrate coma: inefficacy, adverse events, and review.
Clin Toxicol (Phila). 2007; 45(3):261-5.CT

Abstract

Physostigmine has been proposed as an antidote for gamma hydroxybutyrate (GHB) intoxication, based on associated awakenings in 1) patients anesthetized with GHB and 2) five of six patients administered physostigmine for GHB intoxication. However, there are neither well-supported mechanisms for physostigmine reversal of GHB effects, supportive animal studies, nor randomized, placebo-controlled trials demonstrating safety, efficacy, or improved outcomes. We sought to determine the outcomes of patients with GHB-induced coma after a physostigmine treatment protocol was instituted in an urban Emergency Department and ambulance service. Our search of medical records located five cases of GHB toxicity, all with co-intoxicants, who received physostigmine. None demonstrated response and, further, there were associated adverse events, including atrial fibrillation (2), pulmonary infiltrates (1) and significant bradycardia (1), and hypotension (1). We also reviewed 18 published GHB toxicity case series for incidence of adverse effects, stimulant co-intoxicants (which may heighten risk of physostigmine), complications, and outcomes of supportive care for GHB toxicity. We conclude that physostigmine is not indicated for reversal of GHB-induced alteration of consciousness; it is not efficacious, it may be unsafe, particularly in the setting of recreational polydrug use; and supportive care results in universally good outcomes.

Authors+Show Affiliations

Department of Emergency Medicine, Hennepin County Medical Center/Minneapolis, Medical Research Foundation, Minneapolis, Minnesota 55415, USA. dzvosec@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17453877

Citation

Zvosec, Deborah L., et al. "Physostigmine for Gamma-hydroxybutyrate Coma: Inefficacy, Adverse Events, and Review." Clinical Toxicology (Philadelphia, Pa.), vol. 45, no. 3, 2007, pp. 261-5.
Zvosec DL, Smith SW, Litonjua R, et al. Physostigmine for gamma-hydroxybutyrate coma: inefficacy, adverse events, and review. Clin Toxicol (Phila). 2007;45(3):261-5.
Zvosec, D. L., Smith, S. W., Litonjua, R., & Westfal, R. E. (2007). Physostigmine for gamma-hydroxybutyrate coma: inefficacy, adverse events, and review. Clinical Toxicology (Philadelphia, Pa.), 45(3), 261-5.
Zvosec DL, et al. Physostigmine for Gamma-hydroxybutyrate Coma: Inefficacy, Adverse Events, and Review. Clin Toxicol (Phila). 2007;45(3):261-5. PubMed PMID: 17453877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physostigmine for gamma-hydroxybutyrate coma: inefficacy, adverse events, and review. AU - Zvosec,Deborah L, AU - Smith,Stephen W, AU - Litonjua,Regina, AU - Westfal,Richard E J, PY - 2007/4/25/pubmed PY - 2007/5/16/medline PY - 2007/4/25/entrez SP - 261 EP - 5 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 45 IS - 3 N2 - Physostigmine has been proposed as an antidote for gamma hydroxybutyrate (GHB) intoxication, based on associated awakenings in 1) patients anesthetized with GHB and 2) five of six patients administered physostigmine for GHB intoxication. However, there are neither well-supported mechanisms for physostigmine reversal of GHB effects, supportive animal studies, nor randomized, placebo-controlled trials demonstrating safety, efficacy, or improved outcomes. We sought to determine the outcomes of patients with GHB-induced coma after a physostigmine treatment protocol was instituted in an urban Emergency Department and ambulance service. Our search of medical records located five cases of GHB toxicity, all with co-intoxicants, who received physostigmine. None demonstrated response and, further, there were associated adverse events, including atrial fibrillation (2), pulmonary infiltrates (1) and significant bradycardia (1), and hypotension (1). We also reviewed 18 published GHB toxicity case series for incidence of adverse effects, stimulant co-intoxicants (which may heighten risk of physostigmine), complications, and outcomes of supportive care for GHB toxicity. We conclude that physostigmine is not indicated for reversal of GHB-induced alteration of consciousness; it is not efficacious, it may be unsafe, particularly in the setting of recreational polydrug use; and supportive care results in universally good outcomes. SN - 1556-3650 UR - https://wwww.unboundmedicine.com/medline/citation/17453877/Physostigmine_for_gamma_hydroxybutyrate_coma:_inefficacy_adverse_events_and_review_ L2 - https://www.tandfonline.com/doi/full/10.1080/15563650601072159 DB - PRIME DP - Unbound Medicine ER -