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European Pharmaceutical Journal

Acta Facultatis Pharmaceuticae Universitatis Comenianae (formerly)

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Analysis of acute clonazepam intoxications during the ten-year period 2001 - 2010

E. Ondriašová
  • Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University in Bratislava
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ E. Knietlová
  • Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University in Bratislava
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ B. Cagáňová / M. Kuželová
  • Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University in Bratislava
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ S. Plačková
Published Online: 2012-06-19 | DOI: https://doi.org/10.2478/v10219-012-0006-8

Analysis of acute clonazepam intoxications during the ten-year period 2001 - 2010

In the article acute intoxications by clonazepam (Rivotril) consulted with the National Toxicological Information Centre (NTIC) in Bratislava during the years 2001 - 2010 are analysed. 431 records of acute clonazepam intoxications were evaluated according to gender, age, cause, poisoning severity score and therapy. 57% of all patients were female, 42% were male. The highest number, 123, was in the age between 19 - 35 years and 117 between 36 - 50 years, and most of these cases were suicidal attempts (85% and 90%). Accidental poisoning was most common in children under 5 years of age (65 cases). In the age over 65 years were 4 cases. 69% of all evaluated intoxications were suicidal and 18% were accidental. 61% of intoxications were combined, particularly with alcohol and antidepressant, anxiolytic and antiepileptic drugs. The most common poisoning severity score (68% cases) was PSS 1, which means intoxications accompanied by mild, transient and spontaneously resolving symptoms - fatigue, somnolence, ataxia. There were five lethal cases (PSS 4) as the consequence of combined drug intoxications with suicidal intent. Complete data about therapeutical treatment were obtained for 114 patients. In most cases, hospital treatment was non-specific decontamination and supportive symptomatic therapy. 97 patients received activated charcoal, 55 activated charcoal with laxative, 38 gastric lavage and 12 patients were given the specific antidote flumazenil (Anexate).

By retrospective analysis, we found an increasing tendency of clonazepam intoxications mainly suicidal.

In spite of the fact that it is mandatory to report intoxications to the NTIC in the form of a copy of the medical record of each patient hospitalized due to intoxication, there are still medical facilities which don't fulfil this requirement. If all the medical records were available, it would lead to more precise knowledge about intoxications in Slovakia and a better possibility for introducing measures to lower the number and consequences of intoxication.

Analýza akútnych intoxikácií klonazepamom za desaťročné obdobie 2001 - 2010

V práci sú analyzované akútne intoxikácie klonazepamom (Rivotril) konzultované s Národným toxikologickým informačným centrom (NTIC), v Bratislave v rokoch 2001 - 2010. Súbor tvorilo 431 záznamov konzultácií hlásených intoxikácií klonazepamom, ktoré boli hodnotené podľa pohlavia, veku, príčiny (suicidálny pokus, náhoda), stupňa závažnosti intoxikácie a terapie. Z celkového počtu pacientov bolo 57 % žien a 42 % mužov. Najvyšší počet intoxikácií (123) bol zaznamenaný vo vekovej skupine od 19 do 35 rokov a tiež v skupine od 36 do 50 rokov (117), pričom väčšinou išlo o suicidálne intoxikácie (85 % resp. 90 %). Najviac náhodných otráv (65) bolo u detí do 5 rokov. Nad 65 rokov boli zaznamenané 4 intoxikácie. 18 % zo všetkých intoxikácií bolo náhodných a 69 % suicidálnych. Intoxikácie samotným klonazepamom tvorili 39 %. 61 % bolo kombinovaných intoxikácií, hlavne s alkoholom, antidepresívami, anxiolytikami a antiepileptikami. Najčastejšie (68 %) sa vyskytovali mierne intoxikácie (PSS 1). V 5 prípadoch kombinovaných intoxikácií so suicidálnym úmyslom bol stupeň závažnosti PSS 4, t.j. smrteľná intoxikácia. Terapeutické postupy boli vyhodnotené zo 114 prepúšťacích správ pacientov hospitalizovaných kvôli intoxikácii klonazepamom. Prevládala nešpecifická eliminácia a symptomatická a podporná terapia. 97 pacientom bolo podané aktívne uhlie, 55 pacientom aktívne uhlie kombinované s laxatívom, v 38 prípadoch bola vykonaná gastrická laváž a v 12 prípadoch bolo podané špecifické antidotum flumazenil (Anexate). Retrospektívnou analýzou sme zistili stúpajúcu tendenciu intoxikácií klonazepamom, najmä suicidálnych. Napriek tomu, že od roku 2006 je povinné hlásenie intoxikácií NTIC vo forme kópie prepúšťacej správy každého pacienta hospitalizovaného kvôli intoxikácii, sú ešte zdravotnícke zariadenia, ktoré si túto povinnosť neplnia. Ak by boli všetky prepúšťacie správy k dispozícii, znamenalo by to presnejšiu informovanosť o intoxikáciách na Slovensku a lepšiu možnosť zavedenia opatrení na zníženie počtu a následkov intoxikácií.

Keywords: Acute intoxication; Clonazepam; Rivotril; National Toxicological Information Centre

  • PLAČKOVÁ, S., - CAGÁŇOVÁ, B., - KRESÁNEK, J.: National Toxicological Information Centre (in Slovak). Lek. Obz.55, 2006, p. 295.Google Scholar

  • KRESÁNEK, J., - CAGÁŇOVÁ, B., - PLAČKOVÁ, S.: What is new in toxicology? (in Slovak) Pediatria 4, 2009, p. 45N-46N.Google Scholar

  • BARILE, F.A.: Clinical Toxicology. Principles and Mechanisms. New York, Informa Healthcare 2010, 467 p.Google Scholar

  • Clonazepam. Summary of product characteristics. [online]. [cit. 2011-08-02]. http://www.medicines.org.uk/EMC/medicine/1726/SPC/Rivotril+0.5+mg+and+2+mgTablets/

  • RISS, J. - Cloyd, J. - Gates, J. - Collins, S.: Benzodiazepines in Epilepsy: Pharmacology and Pharmacokinetics. Acta Neurol. Scand. 118, 2008, p. 69-86.Web of ScienceGoogle Scholar

  • MORISHITA, S.: Clonazepam as a therapeutic adjunct to improve the management of depression: a brief review. Hum. Psychopharmacol. 24, 2009, p. 191-198.PubMedWeb of ScienceGoogle Scholar

  • CHOUINARD, G.: The search for new off-label indications for antidepressant, antianxiety, antipsychotic and anticonvulsant drugs. J. Psychiatry Neurosci. 31, 2006, p. 168-176.Google Scholar

  • FLOMENBAUM, N.E. - HOWLAND, M.A. - GOLDFRANK, L.R. - LEWIN, N.A. - HOFFMAN, R.S. - NELSON, L.S.: GoldfranksToxicologic Emergencies. New York, McGraw-Hill 2006, 1981 p.Google Scholar

  • KNIETLOVÁ, E.: Analysis of intoxications by clonazepam consulted with the National Toxicological Information Centre during the years 2005 - 2009. [Thesis]. Bratislava, Faculty of Pharmacy, Comenius University 2010Google Scholar

  • POLEWKA, A. - GROSZEK, B. - TARGOSZ, D. - SZKOLNICKA, B. - CHROSTEK MAJ, J. - KROCH, S. - PACH, J.: The frequency of suicide attempts depending on gender and the age structure. Przegl. Lek. 61, 2004, p. 265-268.Google Scholar

  • KUŽELOVÁ, M. - PLAČKOVÁ, S. - KOVÁCS, L. - BENEDEKOVÁ, M. - RIEDEL, R. - CAGÁŇOVÁ, B. - SEGINKO, J. - ŠVEC, P: Analysis of accidental drug intoxications in children hospitalized at the Children's Faculty Hospital in Bratislava in the years 1996-2000 (in Slovak).Čes-slov. Pediat. 59, 2004, p. 341-347.Google Scholar

  • PERSSON, H. - SJÖBERG, G. - HAINES, J. - PRONCZUK DE GARBINO, J.: Poisoning severity score. Grading of acute poisoning. J. Toxicol. Clin. Toxicol. 36, 1998, p. 205-213.CrossrefGoogle Scholar

  • Benzodiazepines. Poisindex. Micromedex Healthcare Series. 149, Colorado, 2011.Google Scholar

  • BÁTORA, I. - PLAČKOVÁ, S.: Gastric lavage - end of a myth (?) (in Slovak). Medicínsky monitor 2004, p. 36-37.Google Scholar

  • Anexate. Summary of product characteristics. [online]. [accessed 8.2.2011]. http://www.medicines.org.uk/EMC/medicine/1676/SPC/Anexate+500+micrograms+5ml+Solution+for+Injection+or+Infusion/

  • PRADO, C.C. - CARVALHO, A.C. - TELINI, A.H.S. - MAIA, M.L.P.C. - DE CAPITANI, E.M. - BUCARETCHI, F.: Death after flumazenil use. Clin. Toxicol. 49, 2011, p. 253-254.Google Scholar

  • FERRER-DUFOL, A. - MENAO, G.S. - LATORRE, G.V. - RAMOS, M. - CIVEIRA, M.E.: Trends in the management of pure benzodiazepine overdoses. The role of the Clinical toxicology unit in improving treatment procedures. Clin. Toxicol. 47, 2009, p. 456.Google Scholar

  • Toxbase. Clonazepam. [online]. [cit. 2011-08-02]. http://www.toxbase.org/Poisons-Index-A-Z/C-products/Clonazepam/

  • VERROTTI, A. - CICCONETTI, A. - SCORRANO, B. - DE BERARDIS, D. - COTELLESSA, C. - CHIARELLI, F. - FERRO, F.M.: Epilepsy and suicide: pathogenesis, risk factors, and prevention. Neuropsychiatr. Dis. Treat. 4, 2008, p. 365-370.Google Scholar

  • MULA, M. - BELL, G.S. - SANDER, J.W.: Suicidality in epilepsy and possible effects of antiepileptic drugs. Curr. Neurol. Neurosci. Rep.10, 2010, p. 327-332.CrossrefGoogle Scholar

About the article

Published Online: 2012-06-19

Published in Print: 2012-01-01

Citation Information: Acta Facultatis Pharmaceuticae Universitatis Comenianae, Volume 59, Issue Supplement VI, Pages 58–66, ISSN (Print) 0301-2298, DOI: https://doi.org/10.2478/v10219-012-0006-8.

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