Supportive care is the mainstay of treatment
Cardiovascular
Norepinephrine (alpha-agonist) for hypotension resistant to IVF
Refractory hypotension may respond to non-selective beta-blockers
Beta-blockers (esmolol preferred due to short half-life) for tachydysrhythmias
GI decontamination (Multidose Activated Charcoal, Whole Bowel Irrigation)
Consider in recent severe overdose
Contraindications: unsecured airway, nausea/vomiting, ileus, Bowel Obstruction, or need for emergent endoscopy
Seizures
Lorazepam (Ativan) 1st line
Phenobarbital if lorazepam ineffective
Phenytoin (Dilantin) contraindicated as increases seizure in animal studies
Dialysis or plasmapheresis
Indicated in seizures, severe arrhythmias, hypotension, serum level >90 μg/mL (>40 μg/mL in chronic ingestion)
Norepinephrine (alpha-agonist) for hypotension resistant to IVF
Refractory hypotension may respond to non-selective beta-blockers
Beta-blockers (esmolol preferred due to short half-life) for tachydysrhythmias
Consider in recent severe overdose
Contraindications: unsecured airway, nausea/vomiting, ileus, Bowel Obstruction, or need for emergent endoscopy
Lorazepam (Ativan) 1st line
Phenobarbital if lorazepam ineffective
Phenytoin (Dilantin) contraindicated as increases seizure in animal studies
Indicated in seizures, severe arrhythmias, hypotension, serum level >90 μg/mL (>40 μg/mL in chronic ingestion)
Theophylline toxicity
Beta-2 agonist toxicity
Clenbuterol toxicity
Sympathomimetic toxicity
SSRI toxicity
Iron toxicity
Caffeine toxicity
Salicylate toxicity