Abstract | BACKGROUND: Although uncommon, severe ergotism continues to occur. The purpose of this study is to describe causes and clinical effects of ergotism in recent years. METHODS: This is an observational case series with data obtained retrospectively from all patients with ergotism referred to Ramathibodi Poison Center in Bangkok, Thailand from January 2006 to August 2013. RESULT: Twelve cases of ergotism were identified. All cases involved ergotamine 1 mg/ caffeine 100 mg combination tablets. Nine cases (75%) were precipitated by drug-drug interactions with CYP3A4 inhibitors. The other cases involved suicidal attempt (2 cases) and pediatric unsupervised ingestion (1 case). Ten patients (83%) had signs of peripheral vascular insufficiency. Five of these patients initially had factitiously low or unmeasurable blood pressure using non-invasive technique and had paradoxical increase following intravenous vasodilator administration. Two patients required partial foot amputations due to gangrene. Two patients, including a 15-month-old boy with an unsupervised ingestion, died. DISCUSSION: CONCLUSION: Critical ergotism continues to occur in Thailand, most commonly associated with the drug-drug interactions.
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Authors | S Srisuma, E J Lavonas, W Wananukul |
Journal | Clinical toxicology (Philadelphia, Pa.)
(Clin Toxicol (Phila))
Vol. 52
Issue 7
Pg. 674-7
(Aug 2014)
ISSN: 1556-9519 [Electronic] England |
PMID | 24978905
(Publication Type: Case Reports, Journal Article, Observational Study)
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Chemical References |
- Cytochrome P-450 CYP3A Inhibitors
- Enzyme Inhibitors
- Vasoconstrictor Agents
- Cytochrome P-450 CYP3A
- CYP3A4 protein, human
- Ergotamine
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Topics |
- Adult
- Biological Availability
- Cytochrome P-450 CYP3A
(metabolism)
- Cytochrome P-450 CYP3A Inhibitors
- Drug Interactions
- Enzyme Inhibitors
(adverse effects)
- Ergotamine
(pharmacokinetics, toxicity)
- Ergotism
(physiopathology, therapy)
- Fatal Outcome
- Female
- Humans
- Hypotension
(etiology)
- Infant
- Male
- Middle Aged
- Peripheral Vascular Diseases
(etiology)
- Poison Control Centers
- Thailand
- Treatment Outcome
- Vasoconstrictor Agents
(toxicity)
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