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Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow oleander (Thevetia peruviona) poisoning including the effect of activated charcoal

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dc.contributor.authorRoberts, D.
dc.contributor.authorSouthcott, E.
dc.contributor.authorPotter, J.
dc.contributor.authorRoberts, M.S.
dc.contributor.authorEddleston, M.
dc.contributor.authorBuckley, N.
dc.date.issued2006
dc.descriptionLink to a related website: http://europepmc.org/articles/pmc2296884?pdf=render, Open Access via Unpaywall
dc.description.abstractIntentional self-poisonings with seeds from the yellow oleander tree (Thevetia peruviana) are widely reported. Activated charcoal has been suggested to benefit patients with yellow oleander poisoning by reducing absorption and/or facilitating elimination. Two recent randomized controlled trials (RCTs) assessing the efficacy of activated charcoal yielded conflicting outcomes in terms of mortality. The effect of activated charcoal on the pharmacokinetics of Thevetia cardenolides has not been assessed. This information may be useful for determining whether further studies are necessary. Serial blood samples were obtained from patients enrolled in an RCT assessing the relative efficacy of single-dose and multiple-dose activated charcoal (SDAC and MDAC, respectively) compared with no activated charcoal (NoAC). The concentration of Thevetia cardenolides was estimated with a digoxin immunoassay. The effect of activated charcoal on cardenolide pharmacokinetics was compared between treatment groups by determining the area under the curve for each patient in the 24 hours following admission, the 24-hour mean residence time, and regression lines obtained from serial concentration points, adjusted for exposure. Erratic and prolonged absorption patterns were noted in each patient group. The apparent terminal half-life was highly variable, with a median time of 42.9 hours. There was a reduction in 24-hour mean residence time and in the apparent terminal half-life estimated from linear regression in patients administered activated charcoal, versus the control group (NoAC). This effect was approximately equal in patients administered MDAC or SDAC. Activated charcoal appears to favorably influence the pharmacokinetic profile of Thevetia cardenolides in patients with acute self-poisoning and may have clinical benefits. Given the conflicting clinical outcomes noted in previous RCTs, these mechanistic data support the need for further studies to determine whether a particular subgroup of patients (eg, those presenting soon after poisoning) will benefit from activated charcoal.
dc.identifier.citationTherapeutic Drug Monitoring, 2006; 28(6):784-792
dc.identifier.doi10.1097/FTD.0b013e31802bfd69
dc.identifier.issn0163-4356
dc.identifier.issn1536-3694
dc.identifier.urihttps://hdl.handle.net/1959.8/90774
dc.language.isoen
dc.publisherLippincott Williams & Wilkins
dc.rightsCopyright status unknown
dc.source.urihttps://doi.org/10.1097/FTD.0b013e31802bfd69
dc.subjectactivated charcoal
dc.subjectoleander
dc.subjectpharmacokinetic
dc.subjectpoisoning
dc.subjectThevetia
dc.titlePharmacokinetics of digoxin cross-reacting substances in patients with acute yellow oleander (Thevetia peruviona) poisoning including the effect of activated charcoal
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9915911614301831

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