Cardiovascular drugs
Bev-Lorraine True, Robert H. Dreisbach in Dreisbach’s HANDBOOK of POISONING, 2001
Single doses of these compounds are not dangerous. Fatalities have been recorded after the following repeated daily doses of anticoagulants: dicumarol, 100 mg; ethyl biscoumacetate, 0.6 g; phenindione, 200 mg. The dangerous dosage of warfarin and diphacinone is 10–100 mg daily. The exposure limit for warfarin and pindone is 0.1 mg/m3. The single-dose LD50 for brodifacoum in rats is 0.67 mg/kg. The single dose of brodifacoum that would be dangerous in humans is unknown.
An outbreak of severe coagulopathy in northern Israel among users of illicit synthetic cannabinoids adulterated with brodifacoum
Published in Clinical Toxicology, 2023
Yael Lurie, Yona Nadir, Ron Hoffman, Asaf Miller, Edna Efrati, Gil Ring, Dana Sonenfeld, Nitai Bar, Hisam Zaidani, Alexander Strizevsky, Mahdi Asali, Ophir Lavon, Daniel Kurnik
We report a large outbreak of severe coagulopathy among users of synthetic cannabinoids adulterated with brodifacoum. Brodifacoum is a long-acting anticoagulant rodenticide that, similarly to the therapeutic oral anticoagulant warfarin, inhibits vitamin K-2,3 epoxide reductase, thus reducing the formation of reduced vitamin K, a cofactor in the γ-carboxylation or post-synthetic modification of clotting factors II, VII, IX and X. Like all long-acting anticoagulant rodenticides, brodifacoum is highly lipophilic, has a long biological half-life (16 to 62 days) [13], and has an approximately 15-fold greater potency than warfarin (IC50 = 0.15 μM for rat microsomal vitamin K-2,3 epoxide reductase, compared to 2.2 μM for warfarin) [14]. Long-acting anticoagulant rodenticides are widely used in agricultural and urban rodent control and encountered in the medical context, mainly after unsupervised ingestion by young children or intentional ingestions by adults [15,16]. Long-acting anticoagulant rodenticides are well absorbed via the gastrointestinal tract, but both animal studies and human case reports provide evidence for effective absorption through the respiratory tract [17–19], explaining the systemic exposure in our patients, almost all of whom were exposed by inhalation.
Pregnancy outcomes after suicide attempts by self-poisoning and drug overdose: experience of a clinical pharmacology consultation service in Izmir, Turkey
Published in Journal of Obstetrics and Gynaecology, 2018
Although some agents can cause bleeding and pregnancy complications, the drugs taken for suicide attempts do not seem to be harmful to the human foetus. In our survey, two pregnant women experienced vaginal bleeding after taking ergotamine or rodenticide. The pregnancy with a high dose of ergotamine exposure resulted in a spontaneous abortion, but the other pregnancies resulted in healthy live births. Ergotamine poisoning can promote uterine contractions, and hence may cause foetal harm or abortion. Ergot alkaloids are contraindicated in all trimesters, but there are no conclusive data of an increased risk of birth defects. Brodifacoum and other superwarfarin rodenticides may also lead to fatal or nonfatal bleeding from any tissue or organ. Single cases resulting in a healthy birth, stillbirth, maternal and neonatal coagulopathy have been described following a rodenticide exposure during pregnancy. Our case of a woman who took brodifacoum at 12 weeks of gestation resulted in a maternal coagulopathy recovered completely. At week 39 of gestation, she delivered a healthy baby weighing 3400 g, measuring 50.1 cm in length (both 50th to 75th percentile).
An outbreak of severe coagulopathy from synthetic cannabinoids tainted with Long-Acting anticoagulant rodenticides
Published in Clinical Toxicology, 2020
Jason M. Devgun, Arkady Rasin, Theresa Kim, Mark B. Mycyk, Sean M. Bryant, Michael S. Wahl, Carol DesLauriers, Livia Navon, Erin D. Moritz, Trevonne M. Thompson, Henry D. Swoboda, Jenny Lu, Steven E. Aks
Brodifacoum and other long-acting anticoagulant rodenticides (LAAR) bind avidly to vitamin K epoxide reductase resulting in a prolonged warfarin-like coagulopathy. There are about 5000–8800 cases of exposures to LAARs reported to US poison centers annually, mostly accidental pediatric oral exposures [2–6]. Intentional oral ingestion is less common, but well described [7,8].
Related Knowledge Centers
- Anticoagulant
- Pesticide
- Rodenticide
- Vitamin K
- Vitamin K Antagonist
- 4-Hydroxycoumarins
- Secondary Poisoning
- Coagulopathy
- Synthetic Cannabinoids
- Ethyl Chloroacetate