Scopolamine Treatment for Patients With Organophosphate Poisoning - Full Text View

Purpose

Organophosphate (OP) compounds are a major threat as chemical warfare agents or in terrorist act. OPs are also the active ingredient of many insecticides. Ingestion of insecticides is a common cause of death among people who commit suicide in developing countries. OPs poisoning also frequently occurs after accidental exposure to agricultural OPs and in children as a result of unintentional ingestion.

The use of competitive inhibitors of acetylcholine other than atropine for patient with organophosphate (OP) poisoning is controversial. Because scopolamines' ability to cross the blood brain barrier is better than atropine, it has been suggested that scopolamine should be used OP poisoned patients who have central nervous system (CNS) manifestations. However there is controversy regarding its potential benefit in the treatment of organophosphate poisoning in humans. To the best of our knowledge there are no randomised controlled studies on the use of scopolamine in humans. This prospective randomised controlled study is aimed to determine whether adding scopolamine to the standard treatment of atropine and oximes in patients with CNS symptoms of OP poisoning improve the outcome.

Condition	Intervention
Neurotoxicity Syndromes	Drug: Placebo


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Scopolamine Treatment for Patients With Organophosphate Poisoning - a Randomized, Double Blind, Placebo-Controlled Study.

Resource links provided by NLM:

MedlinePlus related topics: Poisoning

Drug Information available for: Scopolamine Scopolamine hydrobromide Butylscopolamine bromide

Genetic and Rare Diseases Information Center resources: Neurotoxicity Syndromes

U.S. FDA Resources

Further study details as provided by Assaf-Harofeh Medical Center:

Primary Outcome Measures:

Improvement in neurological status as measured by the Glasgow Coma Scale [ Time Frame: 1 week ]
Duration of seizures. [ Time Frame: 1 week ]
Number of days on ventilator [ Time Frame: 1 week ]

Secondary Outcome Measures:

Total cumulative dose of atropine [ Time Frame: 1 week ]
Need for benzodiazepines [ Time Frame: 1 week ]
Number of days in the ICU [ Time Frame: 2 weeks ]
Adverse effects and complications [ Time Frame: 2 weeks ]
Neurological assessment at discharge [ Time Frame: 2 weeks ]
Neurological assessment 3 month after the exposure [ Time Frame: 3 month ]
Neuro-cognitive assessment at 3 month [ Time Frame: 3 month ]
Survival at 24 hours [ Time Frame: 24 hours ]
Survival to discharge [ Time Frame: 4 weeks ]
Number of days in hospital [ Time Frame: 4 weeks ]


Estimated Enrollment:	50
Study Start Date:	October 2007
Estimated Study Completion Date:	December 2009

Arms	Assigned Interventions
Experimental: A IV Scopolamine 0.25mg in adults and 0.006mg/kg in children Q4h	Drug: Placebo IV placebo q4h
Placebo Comparator: B IV Look alike drug Q 4h	Drug: Placebo IV placebo q4h

Detailed Description:

Objective: to determine whether adding scopolamine to the standard treatment of atropine and oximes improve the outcome of patients with OP poisoning and CNS manifestations. Design: A multi-center, randomized, double blind, placebo controlled study. Setting: Emergency Departments & Intensive Care Units in Israel. Participants: Patients 2 -60 years old with acute OP poisoning and CNS manifestations. Interventions: In addition to standard treatment with atropine and obidoxime, eligible patients will be randomly assigned to one of two treatment groups, scopolamine group, and placebo group (both given in the same volume). Scopolamine will be given IM or IV in a dose of 0.25mg for adults and 0.006mg/kg for children every 4 hours. At least three doses of scopolamine (or placebo) will be given. The medical staff will be blinded to the treatment given. Main outcome measures: Improvement in neurological status, duration of seizures and number of days on ventilator. Data analysis: The main outcome measures, will be compared using the Student's t-test or the Mann-Whitney tests as appropriate. The *2 or Fisher Exact tests, as appropriate, will be used for comparisons of categorical variables. We will use multiple logistic regression to examine the extent to which variables predict success or failure of the treatment.

Eligibility


Ages Eligible for Study:	2 Years to 60 Years (Child, Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age: 2- 60 years
At least two of the following three criteria:
- Known exposure to an organophosphate or carbamate insecticide in the last 72 hours.
- Symptoms and signs typical to organophosphate poisoning involving at least two systems (gastrointestinal, respiratory, skin, eyes,) See appendix
- Low levels of plasma butyrylcholinesterase (less than 50% of the lower normal range )
CNS involvement in the first 72 hours after exposure: determined by finding at least one of the following major criteria or at least two of the minor criteria

Major criteria for CNS involvement:

Seizures
Extrapyramidal or Parkinson like symptoms
Decreased level of consciousness (GCS< 12)

Minor criteria for CNS involvement:

GCS 14-12
Confusion
Hallucinations

Exclusion Criteria:

Hypersensitivity to scopolamine
Glaucoma, narrow-angle (angle-closure)
Tachyarrhythmias, congestive heart failure
Obstructive gastrointestinal disease
Myasthenia Gravis
Reflux esophagitis
Ulcerative colitis
Known obstructive uropathy
Pregnancy
Patient or legal guardian unable to give informed consent (see comment under ethics)
Severe co-morbidity (multi-trauma, advanced cancer, etc)

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00389259

Locations


Israel
Rambam Hospital
Haifa, Israel

Sponsors and Collaborators

Assaf-Harofeh Medical Center

Israeli MOH

International Diabetes Federation

Investigators


Principal Investigator:	Eran Kozer, MD	Assaf-Harofeh Medical Center

More Information


ClinicalTrials.gov Identifier:	NCT00389259 History of Changes
Other Study ID Numbers:	70/04*1
Study First Received:	October 17, 2006
Last Updated:	April 4, 2011

Keywords provided by Assaf-Harofeh Medical Center:


Insecticides Organophosphate Scopolamine randomized control study Organophosphate or carbamate intoxication

Additional relevant MeSH terms:


Neurotoxicity Syndromes Poisoning Organophosphate Poisoning Nervous System Diseases Chemically-Induced Disorders Scopolamine Hydrobromide Butylscopolammonium Bromide Adjuvants, Anesthesia Mydriatics	Autonomic Agents Peripheral Nervous System Agents Physiological Effects of Drugs Cholinergic Antagonists Cholinergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Muscarinic Antagonists Parasympatholytics

ClinicalTrials.gov processed this record on September 19, 2017