II. Background

  1. Single doses as high as 400 mg in adults are well tolerated
  2. Overdose is usually not fatal, unless combined with other serotonergic drugs (Serotonin Syndrome)

III. Signs

  1. Nausea, Vomiting or Diarrhea
  2. Chest Pain including coronary ischemia, Hypertension, Tachycardia or Dysrhythmia
  3. Somnolence, Dizziness, Vertigo or Paresthesias (rarely CVA)
  4. Diaphoresis
  5. Serotonin Syndrome (Agitation, autonomic hyperactivity, Tremor, Clonus)

IV. Evaluation

  1. See Unknown Ingestion including toxicologic evaluation
  2. Serum chemistry panel
  3. Electrocardiogram

V. Approach

  1. See Serotonin Syndrome
  2. Activate charcoal if indicated (significant Overdose with early presentation within 1-2 hours)
  3. Agitation
    1. Benzodiazepines
  4. Refractory symptomatic Hypertension
    1. Nicardipine or Clevidipine
    2. Labetalol
    3. Nitroprusside
    4. Phentolamine
  5. Coronary Ischemia
    1. Nitroglycerin
  6. Dysrhythmia
    1. Amiodarone or Lidocaine
  7. Disposition
    1. May discharge home if asymptomatic at 6 hours after ingestion
    2. Observe and treat symptomatic ingestions

VI. References

  1. Tomaszewski (2022) Crit Dec Emerg Med 36(8): 32

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