Analysis of acute clonazepam intoxications during the ten-year period 2001 - 2010

In the article acute intoxications by clonazepam (Rivotril) consulted with the National Toxicological Information Centre (NTIC) in Bratislava during the years 2001 - 2010 are analysed. 431 records of acute clonazepam intoxications were evaluated according to gender, age, cause, poisoning severity score and therapy. 57% of all patients were female, 42% were male. The highest number, 123, was in the age between 19 - 35 years and 117 between 36 - 50 years, and most of these cases were suicidal attempts (85% and 90%). Accidental poisoning was most common in children under 5 years of age (65 cases). In the age over 65 years were 4 cases. 69% of all evaluated intoxications were suicidal and 18% were accidental. 61% of intoxications were combined, particularly with alcohol and antidepressant, anxiolytic and antiepileptic drugs. The most common poisoning severity score (68% cases) was PSS 1, which means intoxications accompanied by mild, transient and spontaneously resolving symptoms - fatigue, somnolence, ataxia. There were five lethal cases (PSS 4) as the consequence of combined drug intoxications with suicidal intent. Complete data about therapeutical treatment were obtained for 114 patients. In most cases, hospital treatment was non-specific decontamination and supportive symptomatic therapy. 97 patients received activated charcoal, 55 activated charcoal with laxative, 38 gastric lavage and 12 patients were given the specific antidote flumazenil (Anexate).

By retrospective analysis, we found an increasing tendency of clonazepam intoxications mainly suicidal.

In spite of the fact that it is mandatory to report intoxications to the NTIC in the form of a copy of the medical record of each patient hospitalized due to intoxication, there are still medical facilities which don't fulfil this requirement. If all the medical records were available, it would lead to more precise knowledge about intoxications in Slovakia and a better possibility for introducing measures to lower the number and consequences of intoxication.