Analab Overdosage

Manifestation: In severe overdosage, mainly by the IV route, apnea, circulatory collapse, convulsions, cardiac arrest, pulmonary edema, and death may occur. The less severely poisoned patient often has a triad of CNS depression, miosis, and respiratory depression. Serious overdosage is characterized by respiratory depression, extreme somnolence progressing to stupor or coma, constricted pupils, skeletal muscle flaccidity, and cold and clammy skin. Hypotension, bradycardia, hypothermia, pulmonary edema, pneumonia, or shock occurs in 40% or less of patients.
Treatment: Administer a narcotic antagonist (e.g. naloxone). The duration of respiratory depression following overdosage may be longer than the duration of the opioid antagonist, so repeated administration of the antagonist may be necessary; keep the patient under surveillance. Do not give an antagonist in the absence of clinically significant respiratory or cardiovascular depression. Naloxone is the antagonist of choice. If necessary to give an antagonist to an opioids-tolerant patient, administer with extreme caution and by titration with smaller than usual doses.
When treating tramadol hydrochloride overdosage, primary attention should be given to maintaining adequate ventilation along with general supportive treatment. Although an opiate antagonist (e.g., naloxone) will reverse some, but not all, manifestations of tramadol hydrochloride overdosage, the risk of seizures also is increased with naloxone administration. Hemodialysis is unlikely to be helpful in a tramadol hydrochloride overdosage because it removes less than 7% of the administered dose in a 4 hours dialysis period.
In cases of oral overdose, evacuate the stomach by emesis or gastric lavage if treatment can be instituted within 2 hours following ingestion. Do not induce emesis. Absorption of drugs from the GI tract may be decreased by giving activated charcoal which, in many cases, is more effective than lavage. Observe the patient for a rise in temperature or pulmonary complications that may require antibiotic therapy.