Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial
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RESEARCH ARTICLE
Open Access
Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial Fariba Farnaghi1, Razieh Rahmani1, Hossein Hassanian-Moghaddam2,3*, Nasim Zamani2,3, Rebecca McDonald4, Narges Gholami1 and Latif Gachkar5
Abstract Objectives: To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children. Methods: In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg; n = 15) or oral lorazepam (0.05 mg/Kg; n = 15) to prevent relapse of toxicity. Results: The median age [IQR] (range) was 15 [10, 36] (6-144) months. The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The most common symptoms/signs were agitation (29; 96.7%), mydriatic pupils (26; 86.7%), and tachycardia (20; 66.6%). Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. There was no report of benzodiazepine complications in either group. Conclusions: Clonazepam and lorazepam treatment was equally effective at similar doses. However, considering the higher potency of clonazepam, it seems that lorazepam is the safer benzodiazepine for oral maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications. Trial registration: IRCT20180610040036N2, April 18th, 2020. Retrospectively registered. Keywords: Benzodiazepine, Clonazepam, Lorazepam, Treatment, Agitation, Methamphetamine, Toxicity
Background In recent years, Iran has seen a rise in the prevalence of stimulant abuse, including from methamphetamine, methylphenidate, and ecstasy [1–3]. The hidden nature of stimulant abuse among family members has also resulted in a dramatic increase in the frequency of accidental stimulant toxicity in children. Even though accidental opioid * Correspondence: [email protected] 2 Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Department of Clinical Toxicology, Loghman-Hakim Hospital Poison Center, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Kamali St, Tehran, Iran Full list of author information is available at the end of the article
poisonings remain more common in Iranian children [1], this change in adult drug use patterns presents a challenge for clinical practice, since no appropriate antidote exists for stimulant poisoning [4]. The most common signs and symptoms of stimulant toxicity in children are irritability, agitation, hyperactivity, ataxia, seizure, inconsolable or constant body movements, roving eye movements, cortical blindness, hyperthermia, tachycardia, hypertension, vomiting, respiratory distress, and rhabdomyolysis
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