Table 1 Characteristics and risks related to overdose of the drugs implicated in this case
Drug name | Maximal oral daily dosing (adult) 1 | Half-life (adult) | Intoxication signs (non-exhaustive list) 2 | Risk factors for bezoar’s formation in the reported case |
|---|---|---|---|---|
Clomipramine | 250 mg/d | • Clomipramine: 19 - 37 h • Desmethylclomipramine (active metabolite): 54 – 77 h | • Tachycardia, hypotension, orthostasis • PR, QRS, QTc intervals prolongation • Anticholinergic effects (e.g. blurred vision, delirium, agitation, hallucinations, mydriasis, sinus tachycardia, urinary retention) • Seizures, sedation | • Anticholinergic effect • Sustained-release formulation with hypromellose component • Massive tablets ingestion (i.e. 115 tablets, 8,625 g) |
Domperidone | 30 mg/d | ~ 7 h | • QT interval prolongation, cardiac arrhythmia • Restlessness, drowsiness, insomnia, headache, confusion, dizziness and acute dystonic reactions, akathisia, parkinsonian-like symptoms • Diarrhea, dry mouth | • Massive tablet ingestion (i.e. 16 tablets, 160 mg) |
Lorazepam | 10 mg/d | ~ 12 h | • Sedation, dizziness, amnesia, ataxia, slurred speech, lethargy • Hypotension • Hypothermia, respiratory failure • Coma | • Massive tablet ingestion (i.e. 50 tablets, 125 mg) |