Emetine intoxication

Abstract

There is a great variability in the patient's reaction to emetine. The proper dose is not known and the metabolism of the drug is little understood. Variability in preparations, inherent differences in the patients' reactions to the drug, and fluctuations from person to person in the metabolism or excretion of the drug are possible explanations. The type of reaction which is the first index of intoxication is variable, although it is most commonly electrocardiographic. This necessitates daily check of the neurologic, gastro-enteric, and cardioavascular systems to detect the first indication of intoxication.Age did not appear to be a factor in the development of symptoms. We could not in our group of patients predict when or at which dose signs of intoxication were apt to appear, although, except for apparent sensitivity to the drug, symptoms did not occur until the dose reached 10 mg./kg. body weight. Patients in general ill health, with anaemia and debility for example, were more prone to develop symptoms. The same was true of females. Withdrawal of the drug has resulted in rapid return of the findings to normal with an occasional exception in the electrocardiographic pattern. Further study of these changes is desirable. It appears that minor electrocardiographic changes are not necessarily contraindications to completion of the course of therapy. We suggest that this matter rest upon the judgment of the clinician as to the severity and type of disease and the need for emetine. Although emetine is a potent and dangerous drug, when patients are carefully watched-as they are when taking digitalis and other potent drugs-evidences of intoxication can be kept to a minimum and serious results of intoxication can be controlled.