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Intravenous naphazoline intoxication

G A van Montfrans, R P van Steenwijk, A Vyth

    Acta Medica Scandinavica
    |January 1, 1981
    PubMed
    Summary
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    Drug addicts presenting with bradycardia after alleged cocaine use were found to have ingested naphazoline, an alpha-adrenergic agent. Atropine treatment exacerbated symptoms, highlighting the importance of identifying substitute drugs in clinical practice.

    Area of Science:

    • Toxicology
    • Pharmacology
    • Emergency Medicine

    Background:

    • Patients presenting after alleged intravenous cocaine use exhibited symptoms including drowsiness, nausea, headache, and marked sinus bradycardia with premature ventricular beats.
    • Bradycardia in these patients suggested potential intoxication with a parasympathomimetic compound, prompting treatment with atropine.

    Purpose of the Study:

    • To investigate the cause of unusual symptoms in patients presenting after alleged cocaine use.
    • To determine the role of substitute drugs, specifically alpha-adrenergic agents, in cases of suspected cocaine intoxication.
    • To evaluate the impact of atropine on patients intoxicated with naphazoline.

    Main Methods:

    • Clinical observation of nine patients presenting with adverse effects after alleged i.v. cocaine administration.

    Related Experiment Videos

  • Urinalysis of two patients revealed naphazoline, a potent alpha-adrenergic agent.
  • Analysis of alleged cocaine samples confirmed 97% naphazoline HCl content.
  • Pharmacological study in a conscious rabbit involving intravenous naphazoline and subsequent atropine administration.

    • Main Results:

    • Seven of eight patients treated with atropine for bradycardia improved, but one developed severe hypertension and hemiparesis with an intracerebral hematoma.
    • One patient who did not receive medication recovered spontaneously within two days.
    • In rabbits, intravenous naphazoline caused a significant decrease in heart rate (from 167 to 30 beats/min) and a doubling of mean arterial pressure.
    • Atropine administration in rabbits doubled heart rate but also markedly increased mean arterial pressure, indicating adverse effects.

    Conclusions:

    • Naphazoline, an alpha-adrenergic agent, was identified as the causative agent in patients presenting with symptoms mimicking cocaine intoxication.
    • Atropine administration can exacerbate the adverse effects of naphazoline, leading to severe hypertension and neurological complications.
    • Clinicians should consider the possibility of substitute drugs, particularly alpha-adrenergic compounds, in patients presenting after alleged cocaine abuse to guide appropriate therapeutic interventions.