Acute buflomedil intoxication: a life-threatening condition

Area of Science:

• Clinical Toxicology
• Neuropharmacology

Background:

• Buflomedil is a rheological agent and vasodilator used in some European countries.
• Recent reports indicate a significant risk of acute intoxication with buflomedil.

Observation:

• A 15-year-old presented to the ICU in a comatose state with mydriasis, areflexia, hypoxemia, and seizures after ingesting 55 mg/kg of buflomedil.
• Initial management included intubation, mechanical ventilation, and intravenous diazepam for seizures.
• Gastric lavage suggested drug ingestion, and EEG revealed diffuse fast activity with anterior/temporal spikes.

Findings:

• The patient fully recovered after 6 hours of supportive care, though mydriasis persisted.
• Buflomedil blood concentration was 24.8 mg/l, urine 324.4 mg/l, and gastric content 6.9 mg/l, 2-3 hours post-ingestion.
• The p-desmethyl metabolite was detected in urine, suggesting drug metabolism.

Implications:

• Buflomedil intoxication can cause severe neurological toxicity and high mortality, even at relatively low doses (50-60 mg/kg).
• The observed clinical picture suggests a potential neuroleptic-like action of buflomedil.
• There is a need to address the risks associated with the widespread availability of buflomedil due to its potential for serious adverse effects.