Beclometasone/formoterol/propranolol overdose and interactions
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Beclometasone/formoterol/propranolol overdose and interactions Drug interaction and transient visual hallucinations: case report
A 21-year-old woman developed transient visual hallucinations following overdose of propranolol in an attempt to suicide. Concomitantly, she also took overdose of beclometasone/formoterol in an attempt to suicide, that resulted in drug interaction between propranolol and beclometasone/formoterol. The woman was admitted 3 hours after ingestion of her mother’s 30 tablets of propranolol 40mg (30 x 40mg tablets) and inhalation of 50 puffs of her own beclometasone/formoterol (100 µg/6 µg) in an attempt to suicide. She denied consumption of any other medication, drug abuse or alcohol. Her medical history was significant for asthma, but no other pre-existing psychiatric illness. Upon arrival to the hospital, she was fully conscious, oriented and co-operative. Her vital signs, physical examination and laboratory investigations were also normal. Serum investigations showed no evidence or traces of alcohol, benzodiazepines, barbiturates or tricyclic antidepressants. Electrocardiogram was normal. During the initial clinical examination, she experienced transient visual hallucinations, to which she always remained concerned. The woman underwent gastrointestinal de-contamination and cardiovascular monitoring was also initiated. During the 24 hourobservation period, she continued to remain awake, and free of cardiovascular effects despite elevated serum propranolol concentrations in the blood sample. Based on the findings, the hallucinations were attributed to elevated concentrations of propranolol in the brain. There were no electrocardiogram modifications, heart rate changes or decreased blood pressure. There were no episodes of bronchospasms. An unusual association of substances with opposite and antagonistic actions was thus determined. Hence, drug interaction was considered between propranolol (a β-blocker drug) and beclometasone/formoterol (a βagonist drug). No further hallucination episodes were noted. The day after admission, she was discharged in asymptomatic condition. Gallo M, et al. Combined beta-blocker and beta-agonist drugs overdose: An unusual balance. Clinical Toxicology 58: 627, No. 6, 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]
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Reactions 26 Sep 2020 No. 1823
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