Norplus Overdosage

Imidapril hydrochloride: Symptoms of overdosage with imidapril include severe hypotension, shock, stupor, bradycardia, electrolyte disturbances, and renal failure. After ingestion of an overdose, keep patient under close supervision, preferably in an intensive care unit. Monitor serum electrolytes and creatinine frequently. Measures to prevent absorption and hasten elimination such as gastric lavage, administration of adsorbents and sodium sulfate within 30 minutes after intake should be applied if ingestion is recent.
If hypotension occurs, place patient in the shock position and immediately give salt and volume supplementation. Treatment with angiotensin II should be considered. Bradycardia or extensive vagal reactions may be treated with atropine. The use of a pacemaker may be considered.
Imidapril and imidaprilat may be removed from the circulation by hemodialysis. The use of high-flux polyacrylonitrile membranes should be avoided.
Hydrochlorothiazide: The most common signs and symptoms of HCTZ overdose include electrolyte imbalance (hypokalemia, hypochloremia, hyponatremia) and dehydration resulting from excessive diuresis. Other features of overdose are lethargy, nausea and weakness. Lethargy may progress to coma within a few hours with minimal depression of respiratory and cardiovascular function without evidence of dehydration or serum electrolyte changes. Gastrointestinal irritation and hypermotility may occur, and temporary elevation of blood urea nitrogen has been reported.
In the treatment of thiazide overdosage, gastric contents may be evacuated taking caution to avoid aspiration, particularly in unconscious patients. If the patient is conscious, induction of vomiting with ipecac syrup is effective in removing the drug from the stomach. Do not administer cathartics since they tend to promote loss of fluid and electrolytes. Treatment is generally supportive. Monitor serum electrolyte and renal function. Replacement of fluid and electrolytes may be indicated. Measures may be required to maintain respiratory, cardiovascular and renal function. Gastrointestinal irritation is usually of short duration but may be treated symptomatically.
The degree to which HCTZ is removed by hemodialysis has not been established.