Abstract
A 15-year-old girl was admitted to ICU in a comatose state. She presented with mydriasis, areflexia, hypoxemia and seizures. She was immediately intubated and connected to a ventilator. The seizures were reversed with intravenous diazepam. CT scan was negative. EEG showed a diffuse fast activity and theta waves with spikes in the anterior and temporal regions, bilaterally. The gastric lavage was suggestive of drug ingestion. The patient completely recovered after 6 h of mechanical ventilation and supportive management. Mydriasis was still present after the resolution of neurological symptoms. The girl told us she had ingested 10 tablets (3 g–55 mg/kg) of Loftyl (buflomedil) for suicidal intention. The buflomedil concentrations at 2–3 h from ingestion were 24.8 mg/l in the blood, 324.4 mg/l in the urine and 6.9 mg/l in the gastric content. The p-desmethyl metabolite was also identified in the urine. Buflomedil is a rheological agent largely used as a vasodilator in some European countries. Some recent reports have emphasized the risk of acute intoxication with this drug. Relatively low doses (50–60 mg/kg) have been associated with an important neurological toxicity and a high mortality. We suggest that the clinical picture we observed might be related to a neuroleptic-type action of buflomedil. We bring to attention the risk of a large, uncontrolled diffusion of a drug capable to cause serious consequences at relatively low doses.
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References
Martinez Sierra R, Lara B, Torres A (1992) Buflomedil intoxication: the little-known risk. J Toxicol Clin Toxicol 30:305–308
Cochard G, Tanguy L, Dubois A, Sizun J (1991) Suicide mortel par intoxication au buflomedil. Press Méd 20:1739–1740
Blery C, Douet N, Fleureaux O, Artus M, Hermes D, Malledant Y (1992) Intoxication par le buflomedil (Fonzylane). Cah Anesthesiol 40:129–130
Clissold SP, Linch S, Sorkin EM (1987) Buflomedil: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in peripheral and cerebral vascular disease. Drugs 33:430–460
Gundert-Remy U, Weber E, Lam G, Chiou WL, Mann W, Aynilian GH (1981) The clinical pharmacokinetics of buflomedil in normal subjects after intravenous and oral administration. Eur J Clin Pharmacol 20:459–463
Belgian Centre For Drug Surveillance (1987) Depression and extrapyramidal disturbances with buflomedil. Folia Pharmacother 14:79
Treves R, Desproges-Gotteron R (1983) Encephalopatie myoclonique chez une malade traitee par une dose excessive de buflomedil. Press Méd 12:645
Medernach C, Garnier R, Efthymiou ML (1981) Intoxication aigue par le buflomedil. Nouv Press Med 10:3496
Otmane-Telba M, Gury B, Paulien R, Feret R, Nouailhat F (1985) Toxicite neurologique reversible du surdosage au buflomedil. Press Méd 14:286
Athanaselis S, Maravelias C, Michalodimitrakis M, Koutselinis A (1984) Buflomedil concentrations in blood and viscera in a case of fatal intoxication. Clin Chem 30:157
Danel V, Saviuc P, Vincent F, Barret L, Debru JL (1988) Intoxication aigue mortelle au buflomedil. J Toxicol Clin Exp 8:243–246
Enna SJ, Coyle JT (1983) Neuroleptics. In: Enna SJ (ed) Neuroleptics: neurochemical, behavioral, and clinical perspectives. Raven Press, New York
Knight ME, Roberts RJ (1986) Phenothiazine and butyrophenone intoxication in children. Pediatr Clin North Am 33:299
Carless CJD, Buchanan MD (1965) Phenothiazine intoxication in children. JAMA 194:177
Davson H (1980) Physiology of the eye. Academic Press, New York San Francisco
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Alberti, A., Valenti, S., Gallo, F. et al. Acute buflomedil intoxication: A life-threatening condition. Intensive Care Med 20, 219–221 (1994). https://doi.org/10.1007/BF01704705
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DOI: https://doi.org/10.1007/BF01704705