Drug poisoning

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What is it about ?

When the doctor prescribes you medication, he always gives you a well-defined dose. To determine this dose, it takes into account your age, weight and any liver or kidney problems. This dose is important. This is because if the dose is too low, the drugs will not have sufficient effect, and if the dose is too high, the drugs can cause poisoning. Some components of the medicine may not be tolerated by your body well and you may show signs of intoxication.

Most cases of poisoning mainly occur with drugs that can be addictive. We think of sedatives, sleeping pills, antidepressants, antipsychotics and painkillers. There are also drugs that are administered in very low doses (some heart drugs), because there is a fine line between efficacy and toxicity. These drugs also involve danger.

What is its frequency?

Out of 10,000 people who see a general practitioner, about 1.2 suffer from drug poisoning.

With which drugs are you at risk of poisoning?

Benzodiazepines

Most drug poisoning is caused by benzodiazepines. These drugs have a muscle relaxant (muscle relaxant) effect, they calm and reduce anxiety (anxiolytics) and help sleep (sedatives). Some benzodiazepines are quick and short-acting, others are slow and long-acting. Many people tend to take fast-acting benzodiazepines too quickly, precisely because their effect is almost immediate. This naturally increases the risk of overdose, but luckily their effect wears off quickly. Slow-acting benzodiazepines, on the other hand, stay in the body longer.

The risk of poisoning is also greater when combined with the consumption of alcohol and / or the use of other drugs which have an effect on the state of consciousness. The main symptom of benzodiazepine poisoning is drowsiness, and sometimes also low blood pressure and poor breathing. An antidote can be given in the hospital. However, the antidote is only given in exceptional cases, as it can be fatal in the event of simultaneous poisoning by other drugs or alcohol.

Antidepressants

These are especially the tricyclic antidepressants (TCAs), a subgroup of antidepressants, which pose the greatest risk of poisoning. Overdose causes confusion, pupil dilation and fever, as well as an increased risk of heart rhythm disturbances. Symptoms sometimes do not appear until after a few days. These antidepressants slow down the emptying of the stomach. For this reason, hospital treatment usually includes gastric lavage and administration of charcoal to absorb any remaining medicine in the body.

The serotonin reuptake inhibitors (SSRIs) are another large subgroup of antidepressants. This group increases the amount and / or sensitivity of the hormone called “serotonin” in the brain. Most often, poisoning is only a matter of taking at least two drugs at the same time that have this effect, for example a prescription antidepressant and St. John’s Wort, a medicinal plant. Mild symptoms include excessive sweating, nausea, urinary problems, confusion, rapid heartbeat, etc. More severe cases can lead to excessively high body temperature, muscle spasms and ultimately irreversible seizures, hyperthermia, pressure in the brain, and death. Treatment consists of stopping the offending drugs and relieving symptoms. Serotonin syndrome is a serious and potentially fatal side effect of SSRIs. If there are signs of this syndrome, treatment will be started in a hospital, in an intensive care unit.

Antipsychotics

Antipsychotics are a group of drugs that affect dopamine, another substance in the brain. They are used to treat psychosis, mainly in cases of confusion, agitation and hallucinations. Poisoning can lead to reduced heart function and reduced breathing. Other symptoms of poisoning are confusion, dilated pupils, fever, loss of consciousness with seizures, abnormal behavior and abnormal movements. Treatment depends on the symptoms.

Painkillers

The painkillers you can become addicted to are opioids. They have more or less the same effect as morphine. Poisoning from these drugs is manifested by altered consciousness, narrowing of the pupils, impaired breathing, and sometimes also nausea and seizures. The treatment of this poisoning also involves the administration of charcoal. For severe cases, there is an antidote (naloxone).

Other painkillers such as aspirin, paracetamol and anti-inflammatory drugs are available without a prescription, which increases the risk of overdose:

  • for aspirin, the danger is present as soon as an adult of 70 kg takes more than 10 g per day (which corresponds to 20 to 40 tablets). Poisoning is manifested by gastrointestinal problems such as nausea, vomiting, diarrhea and stomach aches, ringing in the ears, seizures, loss of consciousness, low blood sugar, hyperventilation, etc. . Treatment targets symptoms and, in severe cases, kidney dialysis is sometimes necessary.
  • paracetamol also gives signs of intoxication as soon as one takes more than 150mg per kg of body weight (therefore, approximately 10g for a person of 70kg). Like aspirin, it causes intestinal problems. In the next phase, the liver stops functioning. For treatment, an antidote (acetylcysteine) is used.
  • Non-steroidal anti-inflammatory drugs usually cause mild poisoning, mainly characterized by bowel problems and, in rare cases, severe symptoms such as seizures, kidney failure and bleeding disorders.
Medicines for the heart

Medicines for the heart are usually used in very low doses. There is often a very fine line between efficacy and overdose. A very small overdose can therefore already lead to symptoms of poisoning. But this is rare. It is mainly the drugs which act on the pumping force and the electrical activity of the heart that cause the most serious poisonings; vasodilators cause less serious poisoning.

Among these drugs, beta-blockers are a widely used group. They slow down the heart rate and improve the efficiency of the heart muscle. These drugs can very quickly (in just 30 minutes) cause shock to the bloodstream, leading to symptoms such as too slow heartbeat, low blood pressure, cramps, low blood sugar, low blood sugar. water in the lungs (pulmonary edema). They can also trigger or worsen an asthma attack.

Another group consists of calcium channel blockers ; they also improve the functioning of the heart and dilate the arteries. Symptoms in poisoning are similar to those of beta blocker poisoning, but they come on more slowly. It is enough to double the prescribed dose to trigger symptoms. These appear more or less quickly depending on the preparation.

The digoxin is a medicine for the heart, which improves its pumping power while regulating and slowing its rhythm. The risk of overdose is very high with this medicine, especially if you have kidney problems or if you are taking other medicines which affect the amount of digoxin in the blood. Poisoning is manifested by a deterioration of the general condition, confusion, disturbance of color vision, headaches, convulsions, heart rhythm disturbances, etc. There is an antidote.

Others

Medicines for epilepsy can cause stomach and bowel problems, decreased consciousness, seizures, decreased breathing and blood flow. Kidney dialysis treatment is one of the options.

Chloroquine is used to prevent and treat malaria and rheumatic conditions. Overdose can cause rapid depression of blood circulation and respiration. In this case, medicinal charcoal will be administered as soon as possible.

How is the diagnosis made?

The diagnosis is often very difficult to make. The packaging of medicines sometimes allows the doctor to estimate what has been taken and in what quantities. If drug poisoning is suspected, the doctor will find out what type of medicine was taken and examine the pulse, blood pressure, state of consciousness, pupils and body temperature. If in doubt, he will direct you to the emergency department. Other additional examinations (heart, brain, breathing) are also carried out depending on the situation.

What can you do ?

Strictly observe the doses prescribed by the doctor. If you are taking any medicines without a prescription, talk to your doctor or pharmacist. Always inform doctors who do not know you well (specialist, doctor consulted on vacation or on the move, etc.) about the medications you are taking and about any kidney or liver problems.

What can your doctor do?

The doctor may adjust the doses of your medicines to your specific situation and take into account your age, weight, possible kidney or liver problems and other medicines you are using.

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