Review Article

The Role of Renal Replacement Therapy in the Management of Pharmacologic Poisonings

Table 4

Role of hemodialysis in the management of miscellaneous pharmacological poisonings.

MedicationTherapeutic useClassic toxicityTreatmentEfficacy of hemodialysis (HD)

CarbamazepineEpilepsy
Trigeminal neuralgia
Bipolar disorder
Altered mental status
Seizures
Hemodynamic instability
Arrhythmias
SupportiveMay reduce carbamazepine level by about 50% [2123]

PhenobarbitalEpilepsyAltered mental statusSupportiveMay reduce phenobarbital level by up to 59% after 4 h HD [2426]

PhenytoinEpilepsy
Cardiac arrhythmias
Horizontal nystagmus
Ataxia
Altered mental status
Arrhythmias
Hypersensitivity reactions
SupportiveShould be considered in patients with severe poisoning not responding to supportive care [27]

BaclofenSpasticityMuscle hypotonia
Altered mental status
Hemodynamic instability
SupportiveConventional HD can decrease the concentration by up to 79% [2830]

EptifibatideAntiplatelet agent
Acute coronary syndrome
BleedingSupportive
Platelet transfusion
Limited to patients with renal failure experiencing ongoing severe bleeding not responding to supportive care [31]

Diltiazem
Atenolol
Hypertension
Cardiac arrhythmias
Bradycardia
Hemodynamic instability
SupportiveHD may be considered in unstable patient with renal failure not responding to supportive care [32, 33]

LisinoprilHypertension
Heart failure
Renal disease
Acute kidney injury
Hyperkalemia
Hemodynamic instability
Angioedema
SupportiveHD may be considered in unstable patient with renal failure not responding to supportive care [34]

TheophyllineObstructive pulmonary diseaseArrhythmias
Altered mental status
Seizures
SupportiveHD may be considered in unstable patient with renal failure not responding to supportive care [35, 36]

CefepimeAntibioticNeurotoxicity
Altered mental status
SupportiveHD may be considered in unstable patient with renal failure not responding to supportive care [37]

MetronidazoleAntibioticAltered mental status
Seizures
Neuropathy
Gastrointestinal symptoms
SupportiveHD should be considered in patient with metronidazole overdose and renal failure [38]

DapsoneAntibioticHypersensitivity reactions
Methemoglobinemia
Supportive
Methylene blue
HD should be considered in patients not responding to conventional therapy [39]

IsoniazidAntibioticNeurotoxicity
Seizures
Liver toxicity
Supportive
Pyridoxine
HD should be considered in patients not responding to conventional therapy [40]

AcetaminophenAnalgesicLiver failureSupportive
N-Acetylcysteine
Liver transplant
HD may be considered in unstable patients with metabolic acidosis [41]