Retrospective review of Tizanidine (Zanaflex) overdose.

Henry A Spiller, George M Bosse, Larry A Adamson
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引用次数: 33

Abstract

Background: Tizanidine is a centrally acting muscle relaxant with a novel mechanism of action and structurally related to clonidine. There are no large case series of tizanidine exposure.

Methods: Retrospective review of all ingestions involving tizanidine reported to a poison control center from January 2000 through February 2003. Exclusion criteria were polydrug ingestion, no follow-up or lost to follow-up.

Results: There were 121 cases of which 45 patients met entrance criteria. Mean age was 32 years (range 1 to 80). Thirty-seven patients were evaluated in a health care facility of which 27 were admitted for medical care. Clinical effects included lethargy (n = 38), bradycardia (n = 14), hypotension (n = 8), agitation (n = 7), confusion (n = 5), vomiting (n = 3), and coma (n = 2). Mean dose ingested by history was 72 mg (S.D. + 86). The lowest dose associated with hypotension was 28mg, which occurred in a 63-year-old female with a BP of 88/52 and a HR of 54. The lowest dose associated with coma was between 60 mg and 120 mg, which occurred in a 30-year-old female with a HR of 30 and BP of 81/48. There were 6 patients < 6 yrs. The lowest dose with bradycardia and drowsiness in a small child was 16 mg in a 2 YO (weight unknown). All other cases in children < 6 yrs involved ingestion of a single tablet (2 or 4 mg) with only mild drowsiness reported. Therapy in this series was primarily supportive and included pressors in 3 cases and intubation in 3 cases. Naloxone was administered to 7 patients. There was no response to naloxone in 5 patients, poor documentation of response in one, and arousal in one patient. All patients recovered without residual complications.

Conclusion: Clinical manifestations of tizanidine overdose include alterations of mental status, bradycardia, and hypotension. In this series, outcome was good with supportive therapy.

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替扎尼定(Zanaflex)用药过量的回顾性分析。
背景:替扎尼定是一种中枢作用的肌肉松弛剂,其作用机制新颖,结构与可乐定相关。没有大的泰扎尼定暴露病例系列。方法:回顾性分析2000年1月至2003年2月向中毒控制中心报告的所有摄入替扎尼定的病例。排除标准为多种药物摄入、无随访或失访。结果:121例患者中45例符合入组标准。平均年龄32岁(范围1 ~ 80岁)。在一家卫生保健机构对37名患者进行了评估,其中27人接受了医疗护理。临床症状包括嗜睡(38例)、心动过缓(14例)、低血压(8例)、躁动(7例)、精神错乱(5例)、呕吐(3例)、昏迷(2例)。病史平均摄入剂量为72mg (sd + 86)。与低血压相关的最低剂量为28mg,发生于一名63岁女性,血压为88/52,HR为54。与昏迷相关的最低剂量在60 ~ 120 mg之间,发生在一名30岁女性,HR为30,血压为81/48。6例患者< 6岁。2岁儿童出现心动过缓和嗜睡的最低剂量为16毫克(体重未知)。6岁以下儿童的所有其他病例均为单片(2或4毫克),仅报告轻度嗜睡。本系列的治疗主要是支持性的,包括3例加压和3例插管。7例患者给予纳洛酮治疗。5例患者对纳洛酮无反应,1例不良反应记录,1例觉醒。所有患者均痊愈,无遗留并发症。结论:替扎尼定过量的临床表现包括精神状态改变、心动过缓和低血压。在这个系列中,支持治疗的结果很好。
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