Acute buflomedil intoxication: a life-threatening condition

Intensive Care Med. 1994;20(3):219-21. doi: 10.1007/BF01704705.

Abstract

A 15-year-old girl was admitted to ICU in a comatose state. She presented with mydriasis, areflexia, hypoxemia and seizures. She was immediately intubated and connected to a ventilator. The seizures were reversed with intravenous diazepam. CT scan was negative. EEG showed a diffuse fast activity and theta waves with spikes in the anterior and temporal regions, bilaterally. The gastric lavage was suggestive of drug ingestion. The patient completely recovered after 6 h of mechanical ventilation and supportive management. Mydriasis was still present after the resolution of neurological symptoms. The girl told us she had ingested 10 tablets (3 g-55 mg/kg) of Loftyl (buflomedil) for suicidal intention. The buflomedil concentrations at 2-3 h from ingestion were 24.8 mg/l in the blood, 324.4 mg/l in the urine and 6.9 mg/l in the gastric content. The p-desmethyl metabolite was also identified in the urine. Buflomedil is a rheological agent largely used as a vasodilator in some European countries. Some recent reports have emphasized the risk of acute intoxication with this drug. Relatively low doses (50-60 mg/kg) have been associated with an important neurological toxicity and a high mortality. We suggest that the clinical picture we observed might be related to a neuroleptic-type action of buflomedil. We bring to attention the risk of a large, uncontrolled diffusion of a drug capable to cause serious consequences at relatively low doses.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Disease
  • Adolescent
  • Combined Modality Therapy
  • Diazepam / therapeutic use
  • Electroencephalography
  • Fatal Outcome
  • Female
  • Gastric Lavage
  • Humans
  • Hypoxia / chemically induced
  • Intensive Care Units
  • Mydriasis / chemically induced
  • Poisoning / blood
  • Poisoning / complications
  • Poisoning / diagnosis
  • Poisoning / physiopathology
  • Poisoning / therapy
  • Pyrrolidines / blood
  • Pyrrolidines / chemistry
  • Pyrrolidines / poisoning*
  • Respiration, Artificial
  • Seizures / chemically induced
  • Seizures / drug therapy
  • Suicide, Attempted
  • Tomography, X-Ray Computed
  • Vasodilator Agents / blood
  • Vasodilator Agents / chemistry
  • Vasodilator Agents / poisoning*

Substances

  • Pyrrolidines
  • Vasodilator Agents
  • Diazepam
  • buflomedil