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Prolonged anticholinergic delirium following antihistamine overdose. 2007

James Scott, and David Pache, and Greg Keane, and Helen Buckle, and Natalie O'Brien
Mater Kids in Mind Inpatient Unit, Mater Children's Hospital, South Brisbane, Qld., Australia. james.scott@mater.org.au

OBJECTIVE A case of anticholinergic delirium in a female adolescent is described, exploring the pharmacokinetic reasons for the prolonged time course and reviewing the management provided. CONCLUSIONS A 14 year old female hospitalised for depression ingested large quantities of promethazine and cyproheptadine. A severe anticholinergic delirium ensued which resolved after six days, much longer than the expected duration. The likely cause of the prolonged delirium was the interaction of promethazine and fluvoxamine through the inhibition of the CYP2D6 enzyme. The patient's young age, the severity of the poisoning and the use of drugs with anticholinergic properties to manage the delirium may also have contributed. The delirium may have been reversed had a cholinesterase inhibitor been provided soon after the overdose.

UI MeSH Term Description Entries
D011398 Promethazine A phenothiazine derivative with histamine H1-blocking, antimuscarinic, and sedative properties. It is used as an antiallergic, in pruritus, for motion sickness and sedation, and also in animals. Proazamine,Atosil,Diphergan,Diprazin,Isopromethazine,Phenargan,Phenergan,Phensedyl,Pipolfen,Pipolphen,Promet,Prometazin,Promethazine Hydrochloride,Prothazin,Pyrethia,Remsed,Rumergan,Hydrochloride, Promethazine
D003533 Cyproheptadine A serotonin antagonist and a histamine H1 blocker used as antipruritic, appetite stimulant, antiallergic, and for the post-gastrectomy dumping syndrome, etc. Antergan,Dihexazin,Periactin,Peritol,Viternum
D003693 Delirium A disorder characterized by CONFUSION; inattentiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2) Delirium of Mixed Origin,Subacute Delirium,Delirium, Subacute,Deliriums, Subacute,Mixed Origin Delirium,Mixed Origin Deliriums,Subacute Deliriums
D005260 Female Females
D006634 Histamine H1 Antagonists Drugs that selectively bind to but do not activate histamine H1 receptors, thereby blocking the actions of endogenous histamine. Included here are the classical antihistaminics that antagonize or prevent the action of histamine mainly in immediate hypersensitivity. They act in the bronchi, capillaries, and some other smooth muscles, and are used to prevent or allay motion sickness, seasonal rhinitis, and allergic dermatitis and to induce somnolence. The effects of blocking central nervous system H1 receptors are not as well understood. Antihistamines, Classical,Antihistaminics, Classical,Antihistaminics, H1,Histamine H1 Antagonist,Histamine H1 Receptor Antagonist,Histamine H1 Receptor Antagonists,Histamine H1 Receptor Blockaders,Antagonists, Histamine H1,Antagonists, Histamine H1 Receptor,Antihistamines, Sedating,Blockaders, Histamine H1 Receptor,First Generation H1 Antagonists,H1 Receptor Blockaders,Histamine H1 Blockers,Receptor Blockaders, H1,Antagonist, Histamine H1,Classical Antihistamines,Classical Antihistaminics,H1 Antagonist, Histamine,H1 Antagonists, Histamine,H1 Antihistaminics,Sedating Antihistamines
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D018680 Cholinergic Antagonists Drugs that bind to but do not activate CHOLINERGIC RECEPTORS, thereby blocking the actions of ACETYLCHOLINE or cholinergic agonists. Acetylcholine Antagonist,Acetylcholine Antagonists,Anti-Cholinergic,Anticholinergic,Anticholinergic Agent,Anticholinergic Agents,Cholinergic Receptor Antagonist,Cholinergic-Blocking Agent,Cholinergic-Blocking Agents,Cholinolytic,Cholinolytics,Anti-Cholinergics,Anticholinergics,Cholinergic Antagonist,Cholinergic Receptor Antagonists,Agent, Anticholinergic,Agent, Cholinergic-Blocking,Agents, Anticholinergic,Agents, Cholinergic-Blocking,Antagonist, Acetylcholine,Antagonist, Cholinergic,Antagonist, Cholinergic Receptor,Antagonists, Acetylcholine,Antagonists, Cholinergic,Antagonists, Cholinergic Receptor,Anti Cholinergic,Anti Cholinergics,Cholinergic Blocking Agent,Cholinergic Blocking Agents,Receptor Antagonist, Cholinergic,Receptor Antagonists, Cholinergic
D062787 Drug Overdose Accidental or deliberate use of a medication or street drug in excess of normal dosage. Drug Overdoses,Overdose, Drug,Overdoses, Drug

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