Methaqualone
Methaqualone
is a non-barbiturate sedative- hypnotic with anticonvulsant, anaesthetic,
antihistaminic and antispasmodic properties. It was extensively abused in the
past ( Mandrax,Quaalude, Sopor),
which led to its withdrawal from themarket. Combination of methaqualone with
wine (“luding out”) is said to produce powerful euphoria with feelings of
invincibility.
Absorption
of this drug after oral administration is rapid and metabolism occurs in the
liver leading to the formation of numerous hydroxy metabolites. Methaqualone is
completely metabolised by the hepatic microsomal enzyme system, primarily by
hydroxylation. Methaqualone is highly lipid soluble, and also has a slow
biotransformation, leading to a long half-life.
Dizziness,
ataxia, slurred speech, and drowsiness are common in mild intoxication with
methaqualone. Overdose is characterised by ataxia, lethargy, coma (sometimes
preceded by delirium), hyperreflexia, and respiratory arrest. In severe
poisoning, pyramidal signs such as hypertonicity, limb hyperreflexia, clonus,
flailing limb motions, myoclonia and upgoing Babinski responses are common.
Hypotension, absence of EEG activity, muscular hyperactivity, and respira-tory
depression are also common phenomena. Tachycardia, hypotension, and myocardial
infarction have been reported in severe cases. Reversible ECG changes may
occur. Pupils may be somewhat mydriatic and sluggishly responsive, or may be
miotic.
Usual
fatal dose is around 8 grams. Acute ingestion of greater than 800 mg in an
adult is usually considered toxic. Ingestion of as little as one tablet in a
child can cause toxicity.
In
severely intoxicated patients monitor CBC, liver and renal function tests,
platelets, coagulation tests, electrolytes, arterial blood gases, and ECG.
Consider prehospital adminis-tration of activated charcoal as an aqueous slurry
in patients with a potentially toxic ingestion who are awake and able to
protect their airway. Activated charcoal is most effective when administered
within one hour of ingestion. Early gastric lavage is also beneficial.
Treatment is essentially supportive, with emphasis on control of convulsions
and hypotension. Although haemodialysis and haemoperfusion are effective in
removing methaqualone, they should be reserved for life-threatening situations.
Many patients have been success-fully treated without the aid of dialysis.
Forced diuresis is contraindicated because of the possibility of precipitating
pulmonary oedema.
Abrupt
withdrawal following chronic use causes nausea, vomiting, abdominal cramps,
weakness, anxiety, restlessness, tachycardia, hyperreflexia, agitation,
convulsions, and delirium. Death may occur if severe withdrawal is not treated.
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