OVERDOSE
Acute overdoses may produce nausea, vomiting, and CNS
depression including coma with respiratory depression.
Methsuximide poisoning may follow a biphasic course. Following
an initial comatose state, patients have awakened and
then relapsed into a coma within 24 hours. It is believed
that an active metabolite of methsuximide, N-desmethylmethsuximide,
is responsible for this biphasic profile. It is important
to follow plasma levels of N-desmethylmethsuximide in
methsuximide poisonings. Levels greater than 40 µg/mL
have caused toxicity and coma has been seen at levels
of 150 µg/mL.
Treatment:
Treatment should include emesis (unless the patient is
or could rapidly become obtunded, comatose, or convulsing)
or gastric lavage, activated charcoal, cathartics, and
general supportive measures. Charcoal hemoperfusion may
be useful in removing the N-desmethyl metabolite of methsuximide.
Forced diuresis and exchange transfusions are ineffective.
CONTRAINDICATIONS
Methsuximide should not be used in patients with a history
of hypersensitivity to succinimides.
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