베타차단제를 포함한 정신과적 약물 중독: 심혈관계 영향을 중심으로
The Intoxication of Beta Blocker with Psychiatric Drugs Focused on the Cardiovascular Adverse Effects
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Purpose: Beta blocker (BB) has been prescribed for anxiety and panic disorder. Patients intoxicated by psychiatric drugs have often been exposed to BB. Moreover, BB overdose has adverse effects including cardiovascular effects, which can be life-threatening. This study was conducted to identify the characteristics of BB intoxication with psychiatric drugs and the adverse effects on the cardiovascular system. Methods: A single center, retrospective study was performed from January 2010 to December 2015. A total of 4,192 patients visited the emergency department (ED) with intoxication, and 69 with BB intoxication were enrolled. Results: Overall, 64 patients (92.8%) of enrolled patients were intoxicated with drugs prescribed for the purpose of psychiatric disorders. Propranolol was the most common BB (62 cases, 96.2%), and the median dose was 140.0 mg (25%-75% 80.0-260.0). Twenty-four patients (37.5%) had experienced cardiovascular events, and these patients tended to have decreased mentality, hypotension and coingestion with quetiapine. An initial mean arterial pressure (MAP) below 65 mmHg (odds ratio 10.069, 95% confidence interval 1.572-64.481, p=0.015) was identified as a factor of cardiovascular event upon multiple logistic regression analysis. Conclusion: Initial MAP below 65 mmHg was a factor of cardiovascular adverse effect in patients of BB intoxication with psychiatric drugs.
Abstract
Purpose: Beta blocker (BB) has been prescribed for anxiety and panic disorder. Patients intoxicated by psychiatric drugs have often been exposed to BB. Moreover, BB overdose has adverse effects including cardiovascular effects, which can be life-threatening. This study was conducted to identify the characteristics of BB intoxication with psychiatric drugs and the adverse effects on the cardiovascular system. Methods: A single center, retrospective study was performed from January 2010 to December 2015. A total of 4,192 patients visited the emergency department (ED) with intoxication, and 69 with BB intoxication were enrolled. Results: Overall, 64 patients (92.8%) of enrolled patients were intoxicated with drugs prescribed for the purpose of psychiatric disorders. Propranolol was the most common BB (62 cases, 96.2%), and the median dose was 140.0 mg (25%-75% 80.0-260.0). Twenty-four patients (37.5%) had experienced cardiovascular events, and these patients tended to have decreased mentality, hypotension and coingestion with quetiapine. An initial mean arterial pressure (MAP) below 65 mmHg (odds ratio 10.069, 95% confidence interval 1.572-64.481, p=0.015) was identified as a factor of cardiovascular event upon multiple logistic regression analysis. Conclusion: Initial MAP below 65 mmHg was a factor of cardiovascular adverse effect in patients of BB intoxication with psychiatric drugs.
참고문헌 (19)
- Graudins A, "Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies", Br J Clin Pharmacol, 81, pp.453~461 (2016)
- DeWitt CR, "Pharmacology, pathophysiology and management of calcium channel blocker and betablocker toxicity", Toxicol Rev, 23, pp.223~238 (2004)
- Mowry JB, "2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report", J Toxicol Clin Toxicol, 52, pp.1032~1283 (2014)
- Love JN, "Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity", J Toxicol Clin Toxicol, 38, pp.275~281 (2000)
- clinical psychiatry, "Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences", pp.2014, Sadock BJ
- Steenen SA, "Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis", J Psychopharmacol, 30, pp.128~139 (2016)
- Das M, "Panic disorder: propranolol and behavioural therapy", BMJ, 332, pp.1094~ (2006)
- Taylor CB, "Panic disorder", BMJ, 332, pp.951~955 (2006)
- Engebretsen KM, "High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning", J Toxicol Clin Toxicol, 49, pp.277~283 (2011)
- Wax PM, "β-Blocker Ingestion: An EvidenceBased Consensus Guideline for Out-of-Hospital Management", J Toxicol Clin Toxicol, 43, pp.131~146 (2009)
- Jamaty C, "Lipid emulsions in the treatment of acute poisoning:a systematic review of human and animal studies", J Toxicol Clin Toxicol, 48, pp.1~27 (2010)
- Peet M, "The treatment of anxiety with beta-blocking drugs", Postgrad Med J, 64(2), pp.45~49 (1988)
- Laverdure B, "Beta-blocking drugs and anxiety. A proven therapeutic value", Encephale, 17, pp.481~492 (1991)
- Hawton K, "Risk factors for suicide in individuals with depression: a systematic review", J Affect Disord, 147, pp.17~28 (2013)
- Love JN, "Electrocardiographic changes associated with beta-blocker toxicity", Ann Emerg Med, 40, pp.603~610 (2002)
- Reith DM, "Relative toxicity of beta blockers in overdose", J Toxicol Clin Toxicol, 34, pp.273~278 (1996)
- Chen TW, "Propranolol intoxication: three cases’ experiences", Vet Hum Toxicol, 27, pp.528~530 (1985)
- Ducret F, "Deliberate self-overdose with propranolol. Changes in serum levels (author’s transl)", Nouv Presse Med, 7, pp.27~28 (1978)
- Love JN, "Beta blocker toxicity after overdose: when do symptoms develop in adults?", J Emerg Med, 12, pp.799~802 (1994)