Poisoning with 4-aminopyridine: report of three cases

Four-aminopyridine is an acutely toxic avicide considered by the manufacturer to be a bird "repellant" because only a small number of birds are acutely poisoned, become disoriented, and emit a distress cry frightening other members of the flock. Four-aminopyridine dramatically enhances transmission at the neuromuscular junction and other synapses, and has been employed clinically in the treatment of prolonged paralysis caused by antibiotics and muscle relaxants, and in the Eaton-Lambert syndrome. In this paper we report the results of an acute poisoning misadventure in three adult males. We review the animal toxicology, summarize the neurophysiological research using 4-AP as a potassium channel blocker, comment on clinical applications, and outline the management of overdose with this agent.