Overdose nicotine

NRT products have few side effects. Nausea and lightheadedness may indicate nicotine overdose. The patch site may be rotated to minimize skin irritation, and nonprescription hydrocortisone or triamcinolone cream may improve skin irritation. Sleep disturbances are reported in 23% of patients using the patch. 

Nortriptyline (Pamelor). A recent study suggested that the tricyclic antidepressant nortriptyline, like bupropion, is effective in the treatment of smoking cessation. Nortriptyline does not have any significant effect on dopamine reuptake activity, but it does increase norepinephrine availability. Like bupropion, nortriptyline may therefore reduce the physical symptoms of nicotine withdrawal. Because nortriptyline carries the danger of lethality in overdose and has the unfavorable side effect profile of the tricyclics, we do not recommend its use for smoking cessation. However, it does raise the question as to whether other newer antidepressants that increase norepinephrine activity (e.g., venlafaxine, mirtazapine, duloxetine) may also prove to be effective treatments for nicotine withdrawal. 

Ingestion of excessive amounts of nicotine can result in nicotine poisoning, the signs and symptoms of which include pallor, diaphoresis, nausea, vomiting, salivation, abdominal pain, diarrhea, headache, dizziness, auditory and visual disturbance, tremor, confusion, and weakness. Hypotension and respiratory failure develop with large overdoses. The minimum oral acute lethal dose for nicotine in adult humans is estimated to be only 40 to 60 mg. 

Lobelia is a nicotine-like herb that acts as an agonist at the nicotinic ganglion. Consistent with this action, it can be dangerous in an overdose, causing respiratory distress, rapid heart rate, sweating, decreased blood pressure, convulsions, and coma. As a result, the FDA has declared it to be an unsafe herb ( 238). 

Nikethamide is a respiratory and heart stimulant, used beneficially against overdoses of barbiturates and morphine, Also known as Coramine, this compound (A, A-diethylnicolinamide) is made by reaction of nicotinic add esters or the add chloride with diethylamine. Its... 

In studies of its use in treating alcohol, opioid, and nicotine dependence, naltrexone has not been reported to cause depression or dysphoria. Patients who complain of naltrexone-associated dysphoria often have co-morbid depressive disorders or depression resulting from opioid or alcohol withdrawal states (549). Co-morbid depression is not a contraindication to naltrexone. Small pilot studies have supported the use of naltrexone in combination with antidepressants for the treatment of patients with co-mor-bid depression. The risk of non-fatal overdose is significantly increased after naltrexone treatment, as a result of reduced tolerance, compared with patients taking substitution methadone (550). 

A cholinergic crisis should be treated by withdrawing all anticholinesterase medication, mechanical ventilation if required, and atropine i.v. for muscarinic effects of the overdose. The neuromuscular block is a nicotinic effect and will be unchanged by atropine. A resistant myasthenic crisis may be treated by withdrawal of drugs and mechanical ventilation for a few days. Plasmapheresis or immimoglobulin i.v. may be beneficial by removing antireceptor antibodies (see above). 

A consequence of nicotine overdose characterized by palpitations, dizziness, sweating, nausea, or vomiting. 

Carbamazepine is both an important anticonvulsant in therapeutic doses and a powerful proconvulsant in overdose. The therapeutic anticonvulsant mechanism is primarily related to blockade of presynaptic voltage-gated sodium channels. Blockade of the sodium channels is believed to inhibit the release of synaptic glutamate and possibly other neurotransmitters. Carbamazepine is also a powerful inhibitor of the muscurinic and nicotinic acetylcholine receptors, N-methyl-D-aspartate (NMDA) receptors and the central nervous system (CNS) adenosine receptors. In addition, carbamazepine is structurally related to the cyclic antidepressant impramine and in massive overdose may affect cardiac sodium channels. 

Nicotine replacement products have relatively few side effects. Nausea and light-headedness are possible signs of nicotine overdose that warrant a reduction of the nicotine dose. 

Ellects ol overdose may include abdominal cramps, diarrhoea, nausea and vomiting, increased peristalsis, salivation, increased bronchial secretions, sweating and constriction of eye pupil (due to muscarinic ellects). Further effects may include muscular cramps, localised muscle contractions, general weakness, slow heart action and low blood pressure (due to nicotinic effects). 

Drag overdose A fatal case of poisoning with tramadol and nicotine has been reported in a 46-year-old man, who had attached 25 transdermal nicotine patches to his thorax and abdomen and in whom tramadol was detected in femoral venous blood post-mortem (concentration 6.6 mg/1) [49 ]. 

---