AC may adsorb a large amount of diazepam as well as other toxic agents co-ingested if given within 30 min to 1 h. It may show withdrawal symptoms and is contraindicated in the patients with elevated intracranial pressure. In addition, it can precipitate ventricular arrhythmia in those who have co-ingested tricyclic antidepressants. Besides, flumazenil has been reported to show complications like the development of seizures in cases of multiple drug overdose of benzodiazepine along with cyclic antidepressants, cocaine, lithium, methyl xanthine, isoniazid, propoxyphene, monoamine oxidase inhibiter, bupropion hydrogen chloride and cycloserine.
Thereby, the first priority goes to activated charcoal (AC) for gastrointestinal decontamination even if the specific antidote is available. flumazenil may not be appropriate in intentional or accidental diazepam overdose as flumazenil is not as effective when multiple drug overdoses are present. In diazepam intoxication, difficulties occur when other central nervous system (CNS) depressants such as tricyclic antidepressants, opioids or alcohol are taken in addition, which is seen especially among poly drug abusers. Because of wider therapeutic uses, diazepam is also the most common benzodiazepine in poisoning. Among the benzodiazepines, diazepam is one of the most widely used drugs for different clinical purposes such as anxiety, acute alcohol withdrawal, status epilepticus and other convulsive states. Many studies have shown benzodiazepines as one of the major drugs responsible for self-poisoning throughout the world. Another study conducted by Lohani between 19 showed that the hypnosedative drugs ranked first on list followed by analgesic/antipyretics among different pharmaceutical agents responsible for drug overdose or poisoning. A comparative study carried out in central, zonal and district hospitals of Nepal showed that sedative and hypnotics are the most common types of drugs (43%) used for intentional attempt. The percentage of intentional poisoning was found to be higher than accidental poisoning. Among the drugs, benzodiazepines were one of the most commonly used. The most commonly used chemicals for self-harm or poisoning include pesticides (organophosphates), rodenticides (zinc phosphide), drugs (benzodiazepines, paracetamol, phenytoin, fluoxetine, amitriptyline) and alcohol. In developing countries like Nepal, suicidal poisoning is considered as a major problem. KeywordsĪctivated charcoal, drug overdose, diazepam, flumazenil, gastrointestinal decontamination Our results show that standard dose of 50 g of activated charcoal as provided in general poisoning cases is sufficient to prevent diazepam intoxication with or without ethanol. Under the simulated gastrointestinal environmental condition, the activated charcoal adsorbed a sufficient amount of diazepam (200 mg/g-25 mg/g) with maximum at intestinal pH. Surprisingly, in the simulated intestinal fluid, the adsorption patterns were not affected due to presence of 10% ethanol while it was reduced to 76.92 (78.179 74.84) mg at 25% ethanol concentration. In case of 10 and 25% ethanol, adsorption in the simulated gastric fluid were 19.20 (21.23 18.00) and 0.268 (0.286 0.26), respectively. The maximum adsorption capacities (at 95% confidence limits) of activated charcoal were 25 (18.42 31.5) mg and 200 (175.158 224.84) mg diazepam/g activated charcoal at pH values 1.2 and 6.8, respectively. The unabsorbed diazepam in simulated gastric fluid and simulated intestinal fluid (with and without ethanol) was determined by UV spectrophotometer at wavelengths 289 and 256 nm, respectively.
In the adsorption study with ethanol, some of the gastric or intestinal fluid was replaced with an equivalent volume of 10 and 25% ethanol, respectively. The adsorption behaviors of diazepam in both simulated gastric and intestinal pH onto activated charcoal were studied.
In the present study, the effect of pH and ethanol on the adsorption of diazepam in the simulated gastric fluid and the simulated intestinal fluid onto activated charcoal was determined in vitro. DOI: 10.4172/pharmaceutical-sciences.1000161 AbstractÄiazepam ingestion along with ethanol is encountered commonly in drug overdose cases.