Poison Alerts

Since its introduction in 1995, tramadol has become the second most-widely-prescribed opioid analgesic in the US, topped only by combination hydrocodone-acetaminophen. It is most effectively used for chronic, moderate-to-severe pain conditions such as neuropathic pain and osteoarthritis, but it also…

According to marketing slogans from the 1920s, lithium “takes the ouch out of the grouch.” Back then, it was an ingredient in 7UP® soda and sold as a hangover remedy. Long absent from soda, lithium today is a commonly prescribed mood…

Often included in “One Pill Can Kill” lists, sulfonylureas (SU) have the potential for significant toxicity in overdose. These medications were the first orally-active agents to treat Type 2 Diabetes, approved in the late 1950s, but now represent only one class among many newer antidiabetic agents and combination products.

Acetaminophen overdose is very common and if the antidote, n-acetylcysteine, is given within 8 hours it prevents hepatotoxicity in most cases. The revolutionary change in NAC dosing was introduced about 5 years ago, but the complexity of the different concentrations of NAC in each IV bag leads to frequent dosing and administration errors.

It is only natural to assume that an overdose with an agent used to treat diabetes will result in very low blood sugar. This is certainly true with insulin and sulfonylurea agents such as glipizide or glyburide, but it is not the case with metformin overdose. Metformin is one of the most commonly prescribed drugs in the world, used as a first-line treatment for Type 2 diabetes and many off-label indications such as polycystic ovary syndrome, obesity, and antipsychotic-induced weight gain.

It should come as no surprise that bupropion (Wellbutrin®, Aplenzin®, formerly Zyban®, others) can cause serious symptoms in overdose. It is used to treat depression and to reduce cravings in smoking cessation, obesity, and other substance use disorders.

Second-generation antipsychotics (SGA) include aripiprazole (Abilify®), quetiapine (Seroquel®), risperidone (Risperdal®), olanzapine (Zyprexa®) and ziprasidone (Geodon®). They were originally called “atypical neuroleptics” when introduced in the 1990s because they had an “atypical” side effect profile compared to the long-used, first-generation antipsychotics (FGA) such as haloperidol and the phenothiazines.

How to Properly Manage Snake Bites Snake bite calls have been increasing at the Missouri Poison Center signaling the start of snake season as the warmer weather brings snakes (and people!) out of their nests. Most snakes found in Missouri are harmless and beneficial in the ecosystem, but we have five venomous species. We have already seen unnecessary and potentially harmful interventions used in the management of snake bites in hospitals across Missouri. Before you manage your next snake bite, review our recommendations for optimum treatment of a snake bite.

Chloroquine & Hydroxychloroquine Chloroquine (formerly Aralen®) and its close relative Hydroxychloroquine (Plaquenil®) are in the news as potential treatments for COVID-19. Individuals are obtaining supplies of these drugs from both pharmaceutical and non-pharmaceutical sources, intending to use them either as prophylaxis and/or as treatment for COVID-19.

Although they end in “lol,” beta blocker overdoses are no laughing matter. They require careful management since they can cause life-threatening effects. Recently, the Missouri Poison Center updated and clarified its guidelines to ensure the best evidence-based treatment of beta blocker overdoses