Use of neostigmine for the management of drug induced ileus in severe poisonings.
BACKGROUND
Effective whole bowel irrigation may be difficult in the presence of drug-induced ileus. Neostigmine, which inhibits the enzymatic degradation of acetylcholine, has been suggested to improve drug-induced ileus. We present two poisoning cases in which neostigmine was used to facilitate gut decontamination complicated by ileus.


METHODS
A 47-year-old woman, after overdose with sodium valproate, venlafaxine, and ibuprofen, developed ileus that prevented whole bowel irrigation. Neostigmine, 2.5 mg intravenously followed by 1.25 mg three hours later, led to improved bowel transit and successful whole bowel irrigation. A 25-year-old man developed ileus after overdose with venlafaxine, dothiepin, and ethanol. Neostigmine administration led to improved intestinal motility and successful whole bowel irrigation.


CONCLUSIONS
We demonstrate facilitated gut decontamination temporally associated with administration of neostigmine in two patients judged to have drug-induced ileus following overdose. No significant adverse events related to neostigmine were observed.
Chan
Betty
B
Departments of Clinical Toxicology, Prince of Wales Hospital and Westmead Hospital, Sydney, Australia. bschan@ozemail.com.au
Whyte
Ian
I
Dawson
Andrew
A
Downes
Michael
M
D000328:Adult; D000931:Antidotes / Q000494:pharmacology / Q000627:therapeutic use*; D003666:Decontamination / Q000379:methods*; D062787:Drug Overdose / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D045823:Ileus / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000494:pharmacology / Q000627:therapeutic use*; D010277:Parasympathomimetics / Q000494:pharmacology / Q000627:therapeutic use*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D015262:Xenobiotics / Q000506:poisoning
D000931:Antidotes; D010277:Parasympathomimetics; D015262:Xenobiotics; D009388:Neostigmine