Skelan Forte Overdosage

Naproxen sodium: Symptoms of naproxen overdosage may include headache, lethargy, dizziness, drowsiness, epigastric pain, abdominal discomfort, heartburn, indigestion, nausea, transient alterations in liver function, hypoprothrombinemia, renal dysfunction, metabolic acidosis, apnea, disorientation, diarrhea, and vomiting; these symptoms have been generally reversible with supportive care. Gastrointestinal bleeding may also occur. Hypertension, respiratory depression, or coma are rarely reported. Acute renal failure and liver damage are possible in significant overdosage. Anaphylactoid reactions were reported with ingestion of therapeutic doses, and may also occur following an overdose. Since high levels of naproxen sodium may be rapidly absorbed, high and early blood levels should be expected. Convulsions, which may or may not be drug-related, have also been reported.
Manage overdosage by symptomatic and supportive care. Patients seen within 4 hours of ingestion may be treated with emesis, gastric lavage, and/or activated charcoal (60 to 100 g in adults, 1 to 2 g/kg body weight in children) and/or osmotic cathartic. For patients who are comatose, having seizures, or lacks the gag reflex, an endotracheal tube with inflated cuff may be needed during gastric lavage to prevent aspiration of gastric contents. Hemodialysis, forced diuresis, alkalinization of urine, or hemoperfusion may not be beneficial because naproxen sodium is highly protein bound.
Paracetamol: Overdosage of paracetamol usually involves four phases with the following signs and symptoms: Anorexia, nausea, vomiting, malaise, and diaphoresis.
Resolution of Phase I symptoms, and the manifestations of the following: right upper quadrant abdominal pain or tenderness, liver enlargement which may be characterized by abdominal discomfort of "feeling full", elevated bilirubin and liver enzyme concentrations, prolongation of prothrombin time, and occasionally oliguria.
Anorexia, nausea, vomiting, and malaise recur usually three to five days after initial symptom onset; and signs of liver failure (e.g., jaundice, hypoglycemia, coagulopathy, encephalopathy) and possibly kidney failure and cardiomyopathy.
Recovery or progression to fatal complete liver failure.
Immediate medical management is required in the event of an overdose, even if the patient is asymptomatic. Patients should be admitted to hospital for full supportive measures to be instituted. Activated charcoal may be used to reduce GI absorption and should be administered within 1 hour of paracetamol ingestion. Plasma or serum paracetamol assay should be obtained as soon as possible, but no sooner than 4 hours following oral ingestion. As a guide to treatment of acute ingestion, the acetaminophen level can be plotted against time since oral ingestion on a nomogram (Rumack-Matthew). A level ≤150 mcg/mL and absence of toxic symptoms indicate that hepatotoxicity is very unlikely. Higher levels indicate possible hepatotoxicity. For acute poisoning, oral or intravenous acetylcysteine is given if hepatotoxicity is likely based on paracetamol dose or serum level. Acetylcysteine is most effective if given within 8 hours of paracetamol ingestion. If degree of toxicity is uncertain, acetylcysteine should be given until toxicity is ruled out. Liver function tests should be obtained initially and repeated at 24-hour intervals.
Liver failure is treated supportively. Patients with fulminant hepatic failure may require liver transplantation.