A natural muscle relaxant prophylactic is used. Non-depolarizing muscle relaxants (tubarin, pavulon, arduan, anatruxonium, diplacin). Side effects and overdose

Muscle relaxants- drugs that reduce the tone of skeletal muscles with a decrease in motor activity up to complete immobilization.

The mechanism of action - the blockade of H-cholinergic receptors in the synapses stops the supply of a nerve impulse to the skeletal muscles, and the muscles stop contracting. Relaxation goes from top to bottom, from facial muscles to the tips of the toes. The diaphragm relaxes last. Conductivity is restored in the reverse order. The first subjective sign of the end of muscle relaxation is the patient's attempts to breathe on his own. Signs of complete decurarization: the patient can raise and hold his head for 5 seconds, tightly squeeze his hand and breathe on his own for 10-15 minutes without signs of hypoxia. Objectively, the degree of effect of muscle relaxants is determined using the following methods: electromyography, accelomyography, peripheral neurostimulation, mechanomyography.

The time of action of muscle relaxants is prolonged in the presence of such factors: hypotension, hypoxia, hypercapnia, metabolic acidosis, hypovolemia, microcirculation disorders, hypokalemia, deep anesthesia, hypothermia, and the patient's advanced age. The effect on the M-cholinergic receptors of the heart, smooth muscles and the vagus nerve depends on the drug and dose. Some muscle relaxants can trigger the release of histamine. They do not pass through the BBB. The passage through the PB depends on the drug and dose. Not soluble in fats. Binding to blood proteins depends on the drug. The main route of administration is intravenous. When taken in food, they do not act, as they are highly polar.

1. Providing conditions for tracheal intubation. 2. Providing muscle relaxation during surgical interventions to create optimal working conditions for the surgical team without excessive doses of drugs for general anesthesia, as well as the need for muscle relaxation during some diagnostic procedures performed under general anesthesia (for example, bronchoscopy). 3. Suppression of spontaneous breathing for the purpose of mechanical ventilation. 4. Elimination of convulsive syndrome in case of ineffectiveness of anticonvulsants. 5. Blockade of protective reactions to cold in the form of muscle tremors and muscle hypertonicity during artificial hypothermia. 6. Muscle relaxation during reposition of bone fragments and reduction of dislocations in the joints, where there are powerful muscle masses.

Antidote: Prozerin. Anticholinesterase drugs block cholinesterase, the amount of acetylcholine increases and it competitively displaces a non-depolarizing muscle relaxant. Prozerin is used at a dose of 0.03-0.05 mg/kg of body weight. Atropine 0.1% 0.5 ml is administered 2-3 minutes before use to level the side effects of prozerin. intravenously. Decurarization is contraindicated in deep muscle block and any disturbance of water and electrolyte balance. If the effect of prozerin ends earlier than the effect of the muscle relaxant, then recurarization- the resumption of muscle relaxation due to the activation of cholinesterase and a decrease in the amount of acetylcholine in the synaptic cleft.

Substances of this group block H-cholinergic receptors localized on the end plate of skeletal muscles and prevent their interaction with acetylcholine, as a result of which acetylcholine does not cause depolarization of the muscle fiber membrane - the muscles do not contract. This condition is called a neuromuscular block.

Classification:

1 - Competitive anti-depolarizing muscle relaxants- substances that increase the concentration of ACh in the synaptic cleft, which competitively displaces the muscle relaxant from its association with HX receptors and causes depolarization of the postsynaptic membrane, thereby restoring neuromuscular transmission. (alkaloid tubocurarine; drugs - curariform)

a) benzylisoquinolines (tubocurarine, atracurium, mivacurium)

b) aminosteroids (pipecuronium, vecuronium, rocuronium)

Curare-like agents are used to relax skeletal muscles during surgical operations. Under the action of curare-like drugs, the muscles relax in the following sequence: first, the muscles of the face, larynx, neck, then the muscles of the limbs, torso, and lastly the respiratory muscles - breathing stops. When breathing is turned off, the patient is transferred to artificial lung ventilation.

In addition, they are used to eliminate tonic convulsions in tetanus and in strychnine poisoning. At the same time, relaxation of the skeletal muscles helps to eliminate convulsions.

Antagonists of muscle relaxants of antidepolarizing action are anticholinesterase agents. By inhibiting the activity of acetylcholinesterase, they prevent the hydrolysis of acetylcholine and thus increase its concentration in the synaptic cleft. ACh displaces the drug from its association with H-cholinergic receptors, which leads to the restoration of neuromuscular transmission. Anticholinesterase agents (neostigmine) are used to interrupt the neuromuscular block or eliminate residual effects after the administration of antidepolarizing muscle relaxants.

2 - Depolarizing muscle relaxants- Suxamethonium iodide (Ditilin, Listenon, Miorelaksin) Suxamethonium iodide is a double molecule of acetylcholine in its chemical structure.

Suxamethonium interacts with H-cholinergic receptors localized on the end plate of skeletal muscles, like acetylcholine, and causes depolarization of the postsynaptic membrane. At the same time, muscle fibers contract, which manifests itself in the form of individual twitches of skeletal muscles - fasciculations. However, unlike acetylcholine, suxamethonium is resistant to acetylcholinesterase and therefore practically does not break down in the synaptic cleft. As a result, suxamethonium causes a persistent depolarization of the postsynaptic membrane of the end plate.

Side effects: postoperative muscle pain (which is associated with muscle microtrauma during their fasciculations), respiratory depression (apnea), hyperkalemia and cardiac arrhythmias, hypertension, increased intraocular pressure, rhabdomyolysis and myoglobinemia, hyperthermia.

3 - Drugs that reduce the release of ACh - Botox is a preparation of botulinum toxin type A, which prevents the release of ACh from the endings of cholinergic nerve fibers. The heavy chain of botulinum toxin has the ability to bind to specific receptors on nerve cell membranes. After binding to the presynaptic membrane of the nerve ending, botulinum toxin penetrates into the neuron by endocytosis.

Due to the fact that Botox prevents the release of ACh by the endings of sympathetic cholinergic fibers that innervate sweat glands, the drug is used in hyperhidrosis to reduce the secretion of eccrine sweat glands (armpits, palms, feet). Enter intradermally. The effect lasts 6-8 months.

The drug is concentrated at the injection site for some time, and then enters the systemic circulation, does not penetrate the BBB and is rapidly metabolized.

Pain and microhematomas at the injection site, slight general weakness for 1 week are noted as side effects.

Muscle relaxants to relieve muscle spasms, when they resort to taking them? Many acute and chronic diseases of the musculoskeletal system are accompanied by persistent skeletal muscle spasms. This enhances the existing pain syndrome and can help to fix the pathological positions of the affected areas of the body. In addition, spasmodic muscles become tight and sometimes compress nearby neurovascular bundles. Therefore, the treatment regimen for many diseases includes muscle relaxants that allow you to cope with muscle spasms.

How do muscle relaxants work?

After the doctor's recommendations about taking muscle relaxants, people often wonder what it is. Often, by mistake, people start taking antispasmodics (usually No-shpu or drotaverine) and are disappointed without getting the desired effect.

In fact, these are 2 different groups of drugs.

Muscle relaxants act on the striated muscles, which are designed to maintain body position and implement voluntary and automated movements. It is also called skeletal because such muscles are attached to bones. But antispasmodics act mainly on smooth muscle fibers, which are located in the walls of blood vessels and hollow internal organs. Therefore, the indications for these funds are different.

Muscle relaxants are classified according to the mechanism of action. They are central and peripheral, it depends on the area of application of the molecules of the active substance. Each group includes drugs of different molecular structure, which determines the features of their use.

Peripherally acting drugs are depolarizing, non-depolarizing and mixed. They have a curare-like effect, affecting neuromuscular transmission at the level of synapses with acetylcholine receptors.

Non-depolarizing drugs compete with acetylcholine and are also called anti-depolarizing drugs. Due to the content of nitrogen atoms, peripheral muscle relaxants are water-soluble and practically do not penetrate the blood-brain barrier. They are destroyed by the action of digestive enzymes, so they can only be administered parenterally. The drugs of this group are quite powerful, so it is necessary to strictly observe the dosage and control the function of the respiratory muscles against the background of their use.

Central muscle relaxants act at the level of the central nervous system. They influence the formation of excitatory impulses in certain motor areas of the brain and some parts of the spinal cord. The stability of their molecules and the features of pharmacodynamics allow the use of many of these drugs in the form of tablets and solutions for parenteral administration. They are often prescribed for various diseases of the spine and other pathologies of the musculoskeletal system, including outpatient treatment.

Scope of application

Muscle relaxants of central action are included in the protocol of anesthesia for various surgical interventions, since their administration facilitates tracheal intubation and allows you to temporarily block the work of the respiratory muscles if mechanical ventilation (artificial ventilation of the lungs) is necessary. They are also used in traumatology during the reposition of displaced fragments during a fracture to relax large muscle groups. Some drugs are used to relieve resistant convulsive syndrome and in the modern version of electroconvulsive therapy.

Peripheral muscle relaxants have a much wider use, due not only to their ease of use, but also to their higher safety profile.

The most common situations in which drugs of this group are prescribed:

pronounced myofascial syndrome, including supported by psychosomatic and neurotic causes, chronic stress;
chronic pain syndrome of various origins, often due to the presence of muscle spasms;
in the presence of central paralysis (after a stroke, with multiple sclerosis, cerebral palsy).

Simply put, central muscle relaxants are often prescribed for local or radiating to the limbs and neck, with spastic paralysis. And in the presence of muscle tension in the cervical region, an indication for these drugs may be.

Contraindications

The use of muscle relaxants is limited by the presence of renal and hepatic insufficiency, myasthenia gravis and myasthenic syndrome, Parkinson's disease, peptic ulcer, hypersensitivity to the components of the drug.

Epilepsy and convulsive syndrome of other etiology are contraindications for prescribing this group of drugs. But with intractable attacks that threaten cardiac arrest, the doctor may decide to administer muscle relaxants while transferring the patient to mechanical ventilation. At the same time, the use of a muscle relaxant is not a way to combat convulsions, it only allows you to reduce spasm of the upper respiratory tract and respiratory muscles, to achieve controlled breathing.

Muscle relaxants are undesirable for pregnant and lactating women. Such drugs are prescribed only when other methods of treatment are ineffective, if the potential benefit to the mother is higher than the risk of complications in the child.

Side effects and overdose

Against the background of the use of muscle relaxants, the following side effects may appear:

headache, dizziness;
general weakness;
nausea, discomfort in the abdomen;
dry mouth;
lowering blood pressure (mainly when using drugs of peripheral action);
skin rash;
anaphylactic shock;
weakness of the muscles of the face, neck and respiratory muscles (intercostal muscles and diaphragm) - with the use of peripheral muscle relaxants.

Failure to comply with the doctor's recommendations and unauthorized excess of the permissible dose is fraught with the development of an overdose, which can be life-threatening. But pronounced side effects can develop against the background of the average therapeutic dose of the drug. When using peripheral muscle relaxants, this may be due to acetylcholine deficiency due to congenital features or the use of other drugs.

Enhance action muscle relaxants alcohol, psychotropic drugs and drugs that affect the rate of metabolism of drugs in the liver.

An overdose of muscle relaxants requires emergency care. Since there is a high risk of respiratory arrest due to inhibition of the work of the respiratory muscles, they try to hospitalize the patient in the intensive care unit. If antidepolarizing drugs have been used, proserin or other anticholinesterase agents are introduced into the treatment regimen. There are no antidotes for other muscle relaxants, therefore, in all other cases, blood purification methods, mechanical ventilation, and symptomatic therapy are used.

Main Representatives

The list of the most commonly used centrally acting muscle relaxants in the Russian Federation includes drugs such as Baclofen, Sirdalud, Mydocalm and their analogues.

In addition, agents of other pharmaceutical groups with additional muscle relaxant action can also be used - for example, tranquilizers and memantine preparations.

And in aesthetic cosmetology, Mirra muscle relaxant cream (of plant origin) and botulinum toxin preparations are used. Clinical practice and reviews show that they allow you to achieve a clear and lasting relaxation of facial muscles with increased tone.

Muscle relaxation with the elimination of spasms of skeletal muscles allows you to influence one of the important mechanisms for the development of pain, improve the patient's condition with spastic paralysis, and even increase visual attractiveness. But muscle relaxants should not be used uncontrollably, because these drugs can cause serious side effects. In addition, contacting a doctor will clarify the cause of the symptoms and select the most appropriate complex treatment regimen.

In medicine, quite often there are situations when it is necessary to relax muscle fibers. For these purposes, they are introduced into the body, they block neuromuscular impulses, and the striated muscles relax.

Medicines of this group are often used in surgery, to relieve convulsions, before repositioning a dislocated joint, and even during exacerbations of osteochondrosis.

The mechanism of action of drugs

With severe pain in the muscles, a spasm may occur, as a result, movement in the joints is limited, which can lead to complete immobility. This issue is especially acute in osteochondrosis. Constant spasm interferes with the proper functioning of muscle fibers, and, accordingly, the treatment is stretched indefinitely.

To bring the patient's general well-being back to normal, muscle relaxants are prescribed. Preparations for osteochondrosis are quite capable of relaxing muscles and reducing the inflammatory process.

Given the properties of muscle relaxants, we can say that they find their application at any stage of the treatment of osteochondrosis. The following procedures are more effective in their application:

Massage. Relaxed muscles respond best to exposure.
Manual therapy. It's no secret that the effect of a doctor is the more effective and safer, the more relaxed the muscles.
Physiotherapy procedures.
The effect of painkillers is enhanced.

If you often experience or suffer from osteochondrosis, then you should not prescribe muscle relaxants on your own, drugs in this group should only be prescribed by a doctor. The fact is that they have a fairly extensive list of contraindications and side effects, so only a doctor can choose a medicine for you.

Classification of muscle relaxants

The division of drugs in this group into different categories can be considered from different points of view. If we talk about what muscle relaxants are, there are different classifications. Analyzing the mechanism of action on the human body, only two types can be distinguished:

Peripheral drugs.
Central muscle relaxants.

Medicines can have a different effect in duration, depending on this, they distinguish:

Ultra short action.
short.
Medium.
Long.

Only a doctor can know exactly which drug is best for you in each case, so do not self-medicate.

Peripheral muscle relaxants

Able to block nerve impulses that pass to muscle fibers. They are widely used: during anesthesia, with convulsions, with paralysis during tetanus.

Muscle relaxants, drugs of peripheral action, can be divided into the following groups:

All of these drugs affect cholinergic receptors in skeletal muscles, and therefore are effective for muscle spasms and pain. They act quite gently, which allows them to be used in various surgical interventions.

Central acting drugs

Muscle relaxants of this group can also be divided into the following types, given their chemical composition:

Derivatives of glycerin. These are Meprotan, Prenderol, Isoprotan.
Based on benzimidazole - "Flexin".
Mixed drugs, such as Mydocalm, Baclofen.

Central muscle relaxants are able to block reflexes that have many synapses in muscle tissue. They do this by reducing the activity of interneurons in the spinal cord. These drugs not only relax, but have a wider effect, which is why they are used in the treatment of various diseases that are accompanied by increased muscle tone.

These muscle relaxants have practically no effect on monosynaptic reflexes, so they can be used to remove and not turn off natural breathing.

If you are prescribed muscle relaxants (drugs), you can find the following names:

"Metacarbamol".
"Baclofen".
"Tolperizon".
"Tizanidin" and others.

It is better to start taking medications under the supervision of a doctor.

The principle of using muscle relaxants

If we talk about the use of these drugs in anesthesiology, we can note the following principles:

Muscle relaxants should be used only when the patient is unconscious.
The use of such drugs greatly facilitates artificial ventilation of the lungs.
It is not the most important thing to remove, the main task is to carry out comprehensive measures for the implementation of gas exchange and maintaining blood circulation.
If muscle relaxants are used during anesthesia, then this does not preclude the use of anesthetics.

When drugs of this group firmly entered medicine, one could safely talk about the beginning of a new era in anesthesiology. Their use allowed us to simultaneously solve several problems:

After the introduction of such drugs into practice, anesthesiology was able to become an independent industry.

Scope of muscle relaxants

Considering that substances from this group of drugs have an extensive effect on the body, they are widely used in medical practice. The following directions can be listed:

In the treatment of neurological diseases that are accompanied by increased tone.
If you use muscle relaxants (drugs), lower back pain will also recede.
Before surgery in the abdominal cavity.
During complex diagnostic procedures for certain diseases.
During electroconvulsive therapy.
When conducting anesthesiology without turning off natural breathing.
For the prevention of complications after injuries.
Muscle relaxants (drugs) for osteochondrosis are often prescribed to patients.
To facilitate the recovery process after
The presence of an intervertebral hernia is also an indication for taking muscle relaxants.

Despite such an extensive list of the use of these drugs, you should not prescribe them yourself, without consulting a doctor.

Side effects after taking

If you have been prescribed muscle relaxants (drugs), lower back pain should definitely leave you alone, only side effects can occur when taking these drugs. On some it is possible, but there are more serious ones, among them it is worth noting the following:

Reduced concentration, which is most dangerous for people sitting behind the wheel of a car.
Lowering blood pressure.
Increased nervous excitability.
Bed-wetting.
allergic manifestations.
Problems from the gastrointestinal tract.
Convulsive conditions.

Especially often, all these manifestations can be diagnosed with the wrong dosage of drugs. This is especially true for antidepolarizing drugs. It is urgent to stop taking them and consult a doctor. Neostigmine solution is usually prescribed intravenously.

Depolarizing muscle relaxants are more harmless in this regard. When they are canceled, the patient's condition is normalized, and the use of medications to eliminate symptoms is not required.

You should be careful to take those muscle relaxants (drugs), the names of which are unfamiliar to you. In this case, it is better to consult a doctor.

Contraindications for use

Taking any medications should be started only after consulting a doctor, and these medications even more so. They have a whole list of contraindications, among them are:

They should not be taken by people who have kidney problems.
Contraindicated in pregnant women and nursing mothers.
Psychological disorders.
Alcoholism.
Epilepsy.
Parkinson's disease.
Liver failure.
Children's age up to 1 year.
Ulcer disease.
Myasthenia.
Allergic reactions to the drug and its components.

As you can see, muscle relaxants (drugs) have many contraindications, so you should not harm your health even more and start taking them at your own peril and risk.

Requirements for muscle relaxants

Modern drugs should not only be effective in relieving muscle spasm, but also meet certain requirements:

One of these drugs, which practically meets all the requirements, is Mydocalm. This is probably why it has been used in medical practice for more than 40 years, not only in our country, but also in many others.

Among the central muscle relaxants, it differs significantly from others for the better. This drug acts on several levels at once: it removes increased impulses, suppresses the formation in pain receptors, and slows down the conduction of hyperactive reflexes.

As a result of taking the drug, not only muscle tension decreases, but also its vasodilating effect is observed. This is perhaps the only drug that relieves spasm of muscle fibers, but does not cause muscle weakness, and also does not interact with alcohol.

Osteochondrosis and muscle relaxants

This disease is quite common in the modern world. Our lifestyle gradually leads to the fact that back pain appears, to which we try not to react. But there comes a point when the pain can no longer be ignored.

We turn to the doctor for help, but precious time is often lost. The question arises: "Is it possible to use muscle relaxants in diseases of the musculoskeletal system?"

Since one of the symptoms of osteochondrosis is muscle spasm, it makes sense to talk about the use of drugs to relax spasmodic muscles. During therapy, the following drugs from the group of muscle relaxants are most often used.

In therapy, it is usually not customary to take several drugs at the same time. This is provided so that you can immediately identify side effects, if any, and prescribe another medicine.

Almost all drugs are available not only in the form of tablets, but there are also injections. Most often, with severe spasm and severe pain syndrome, the second form is prescribed for emergency assistance, that is, in the form of injections. The active substance penetrates into the blood faster and begins its therapeutic effect.

Tablets are usually not taken on an empty stomach, so as not to harm the mucous membrane. You need to drink water. Both injections and tablets are prescribed to be taken twice a day, unless there are special recommendations.

The use of muscle relaxants will only bring the desired effect if they are used in complex therapy, a combination with physiotherapy, therapeutic exercises, and massage is mandatory.

Despite their high effectiveness, you should not take these drugs without first consulting with your doctor. You can't decide for yourself which medicine is right for you and will have the best effect.

Do not forget that there are a lot of contraindications and side effects that should not be discounted either. Only competent treatment will allow you to forget about pain and spasmodic muscles forever.

The drugs of this group block mainly the transmission of nerve impulses at the level of neuromuscular synapses of the striated muscles. These include: tubocurarine chloride, diplacin, cyclobutonium, qualidil, anatruxonium, dioxonium, dithylin (listenone, myorelaxin), mellitin, condelfin. All these are synthetic substances, with the exception of mellictine and condelfin, alkaloids from various types of larkspur.

There are preparations of depolarizing (ditilin) and competitive, antidepolarizing (all other means) action. Under the action of depolarizing curare-like agents, a persistent depolarization of the end plates occurs, followed by relaxation of the skeletal muscles.

Antidepolarizing curare-like drugs block n-cholinoreceptors of neuromuscular synapses and thereby exclude

mediator functions of acetylcholine, which transfers excitation from the motor neuron to the skeletal muscle, which leads to relaxation of the latter.

pathogenesis of poisoning. Ingestion of toxic doses of muscle relaxants, their overdose or increased sensitivity to them, including hereditary ones, cause paralysis of the respiratory intercostal muscles and diaphragm, and as a result, asphyxia occurs. Therefore, muscle relaxants during surgery are used only with intubation anesthesia and the presence of all conditions necessary for controlled breathing. Inhalation drugs (ether, halothane), antibiotics (neomycin, streptomycin sulfate) can cause neuromuscular blockade, which should be taken into account when they are used together with muscle relaxants. The relaxing effect of the latter is enhanced by complications associated with drug overdose (anoxia, hypercapnia, acidosis), electrolyte imbalance (hypokalemia, hypocalcemia) and blood loss during anesthesia. Circulatory failure in the case of the toxic effect of curare-like drugs is associated with hypotension and is usually secondary due to developing respiratory depression. Curare-like drugs of the antidepolarizing type of action are also characterized by a ganglion-blocking effect and the release of histamine from tissues, which, in case of an overdose, can be an additional cause of a hypotonic state.

Depending on the mechanism of relaxation, the approach to the treatment of poisoning with curare-like drugs is different. In case of an overdose of antidepolarizing agents, the use of anticholinesterase agents that increase the concentration of acetylcholine in the area of the end plates is a method of antidote therapy. In case of poisoning with depolarizing agents, the use of these same agents can enhance the phenomena of depolarization and lead to a deepening of the neuromuscular block.

Diplacin. In relatively large quantities does not interfere with blood circulation. When administered intravenously in doses of 3-4 microns/kg, the drug causes complete muscle relaxation and apnea in 5-6 minutes. The duration of the last 20-25 minutes. After breathing is restored, muscle relaxation persists for a long time. With repeated administration, the effect is enhanced, so the dose should be reduced by 1/3-1/2 of the original. The antidote of diplacin, although not always effective enough, is prozerin.

Ditilin- a short-term muscle relaxant, as it is easily hydrolyzed in the body by the enzyme butyrylcholine-sterase of blood serum. In malignant diseases and liver diseases, accompanied by a decrease in the production of this enzyme, with often occurring congenital hypocholine-esteremia, there is an increased sensitivity to ditilin. This is also observed in kidney diseases, which impairs the release of dithylin.

With a single intravenous injection of the drug at a dose of 0.2-0.3 mg / kg of body weight (1-2 ml of a 1% solution), after 1-1.5 minutes, the maximum effect can occur (without stopping breathing) lasting up to 3-7 minutes . If ditilin is administered in doses of 1-1.7 mg/kg, there is a complete relaxation of the muscles and apnea lasting 5-7 minutes. To obtain a longer relaxation of the muscles, you can use its drip or fractional administration. In this case, the mechanism of action may change - the depolarization block is replaced by a competitive one. As a result, in case of an overdose of dithylin after prolonged or repeated use, nroserine can be used cautiously as an antagonist.

Symptoms of poisoning are: heaviness of the eyelids, diplopia, difficulty in speech and swallowing, paralytic condition of the muscles of the extremities, neck, intercostal and, last but not least, the diaphragm. Breathing is superficial, intermittent, rapid, with a pause after exhalation and inhalation. In case of an overdose, severe bradycardia may occur with a sharp decrease in blood pressure.

First aid and treatment. When breathing is off, controlled oxygen breathing must be applied immediately. For the purpose of decurarization, when prescribing antidepolarizing agents (diplacin, etc.), 3 ml of a 0.05% solution of proserin are administered intravenously against the background of 0.5-1 ml of a 0.1% solution of atropine sulfate. The latter is prescribed to limit the stimulation of prozerin n-cholinergic receptors of muscles and autonomic nodes. The decurarizing effect of prozerin is enhanced by intravenous administration of chloride or calcium gluconate (5-10 ml of a 5% solution).

Persistent hypotension is eliminated by intravenous administration of sympathomimetic amines (ephedrine hydrochloride, norepinephrine hydrotartrate).

If dithylin is overdosed, a transfusion of fresh blood or plasma is recommended to replenish butyrylcholinesterase reserves, as well as plasma-substituting drugs. With repeated administration of large doses of the drug that has an antidepolarizing effect, some authors consider it appropriate to use proserin.

Treatment of acute poisoning, 1982