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Scopolamine Treatment for Patients With Organophosphate Poisoning

This study has been withdrawn prior to enrollment.
Sponsor:
Collaborators:
Israeli MOH
International Diabetes Federation
Information provided by:
Assaf-Harofeh Medical Center
ClinicalTrials.gov Identifier:
NCT00389259
First received: October 17, 2006
Last updated: April 4, 2011
Last verified: March 2010
  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
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, 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:


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
Genders Eligible for Study:   Both
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

No publications provided

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
Health Authority: Israel: Israeli Health Ministry Pharmaceutical Administration

Keywords provided by Assaf-Harofeh Medical Center:
Insecticides
Organophosphate
Scopolamine
randomized control study
Organophosphate or carbamate intoxication

Additional relevant MeSH terms:
Neurotoxicity Syndromes
Organophosphate Poisoning
Chemically-Induced Disorders
Nervous System Diseases
Poisoning
Butylscopolammonium Bromide
Scopolamine Hydrobromide
Adjuvants, Anesthesia
Autonomic Agents
Central Nervous System Agents
Cholinergic Agents
Cholinergic Antagonists
Molecular Mechanisms of Pharmacological Action
Muscarinic Antagonists
Mydriatics
Neurotransmitter Agents
Parasympatholytics
Peripheral Nervous System Agents
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on November 27, 2014