Human & Experimental Toxicology

 

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Human & Experimental Toxicology, Vol. 26, No. 2, 131-133 (2007)
DOI: 10.1177/0960327107070670

How much is too much? Oligosymptomatic presentation after 11.5 g of diphenhydramine

Sonia Frick

Department of Internal Medicine, Stadtspital Triemli, Zurich, Switzerland, sonia. frick{at}triemli.stzh.ch

Markus Roos

Department of Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland

Karin Fattinger

Division of Clinical Pharmacology and Toxicology, Department of Medicine, University Hospital Zurich, Switzerland

We report the case of a 47-year-old male obese Caucasian patient presenting 2 hours after ingestion of 11.5 g of diphenhydramine. Despite this excessive overdose, he showed only a few hours of impaired consciousness and no further symptoms. A diphenhydramine plasma concentration of 15 352 nmol/L was measured 8 hours after the overdose ingestion. A heterogeneous CYP2D6 extensive metabolizer genotype excludes a pharmacokinetic explanation for this unusually oligosymptomatic presentation. However, the patient suffered from longstanding, refractory depression despite numerous treatment attempts with various drugs, pointing to the possibility of decreased pharmacodynamic responsiveness for therapeutic and toxic effects. Human & Experimental Toxicology (2007) 26, 131-133

Key Words: antihistaminics • diphenhydramine • overdose


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