Drug poisoning is the voluntary or accidental ingestion of a non-prescribed or prescribed drug in a toxic dose. The body's response to high doses of drugs may differ between individuals. Usually, the treatment is done according to the needs and findings of the person. Although it can be seen in people of all ages, it is more common under the age of five. Symptoms of drug poisoning are manifested by symptoms related to the drug taken, as well as general poisoning symptoms.

Drugs are the most common cause of all poisoning cases. It is the second most common after food poisoning in adults. Drug poisoning usually develops as a result of suicide in adults and as a result of accident in children.

Drug poisoning is the voluntary or accidental ingestion of a non-prescribed or prescribed drug in a toxic dose. The body’s response to high doses of drugs may differ between individuals. Usually, the treatment is done according to the needs and findings of the person. Although it can be seen in people of all ages, it is more common under the age of five. Symptoms of drug poisoning are manifested by symptoms related to the drug taken, as well as general poisoning symptoms.

Table of contents

Common drug poisonings include:

Paracetamol poisoning: 

Paracetamol is an over-the-counter, easily accessible drug. It is widely used due to its analgesic and antipyretic effect. It can be used at almost any age.

Required doses for paracetamol poisoning :
  • Taking 10 g (20 tablets) or 200 mg/kg at a time for 6 years and older (acute poisoning),
  • For those aged 6 years and above, taking 6 g for two consecutive days,
  • 200 mg/kg at one time for under 6 years old,
  • Taking 100 mg/kg for two consecutive days for under 6 years old,
  • Taking 4 g (8 tablets) or 100 mg/kg at a time in alcohol dependents.

Paracetamol poisoning symptoms :

The clinical picture in paracetamol poisoning is evaluated in 4 stages.

  • Stage 1: (first 24 hours) may be asymptomatic or weakness, loss of appetite, nausea, vomiting.
  • Stage 2: (2-3 days) In addition to Stage 1 findings, there may be pain in the right upper quadrant of the abdomen, liver failure, and increased bilirubin.
  • Stage 3: (3-4 days) Jaundice, encephalopathy, inability to urinate may occur.
  • Stage 4: Liver failure, hepatic coma, organ failures, death may occur.

Diagnosis in paracetamol poisoning : 

The level of paracetamol in the blood is checked. In addition, liver and kidney functions are tested.

  1. If the blood paracetamol level is over 200 mg/kg per hour, liver damage occurs in a very large extent.

Paracetamol poisoning treatment :

  • The patient’s vital signs are evaluated. Respiratory support is provided as needed, vascular access is kept open. The blood glucose level is evaluated.
  • If the patient has been treated within the first 4 hours, activated charcoal is applied and gastric lavage (washing) is performed.
  • NAC (N acetylcysteine) is used as an antidote in paracetamol poisoning. It prevents liver damage if given within the first 8 hours.

Aspirin (Salicylate) poisoning: 

Aspirin is widely used as a pain reliever, antipyretic and blood thinner. Due to its blood thinning properties, it is given in addition to other drugs in cardiovascular diseases and cerebrovascular diseases.



Aspirin poisoning may be due to high-dose acute intake or to chronic low-dose intake. The severity of poisoning may vary depending on the amount taken, the duration of intake, and the characteristics of the person (age, additional disease, etc.).

Doses required for aspirin (salicylate) poisoning :
  • Mild poisoning: 150 mg/kg/day ingestion.
  • Moderate poisoning: 150-300 mg/kg/day ingestion.
  • Severe poisoning: Ingestion at doses above 300 mg/kg/day.

Symptoms of aspirin (salicylate) poisoning i:

  • Mild signs of poisoning:
    • Nausea, Vomiting,
    • Tinnitus,
    • Dizziness,
    • Hearing problems.
  • Moderate signs of poisoning:
    • Mild signs of poisoning
    • Increase in respiratory rate,
    • Fire,
    • Sweating,
    • Overstimulation,
    • Ataxia,
  • Signs of severe poisoning:
    • Moderate poisoning symptoms
    • Heart rhythm disorders,
    • Clouding of consciousness,
    • Seizures,
    • Lung problems,
    • Kidney problems,
    • Coagulation problems,
    • Hypotension,
    • Dehydration symptoms

Diagnosis of aspirin (salicylate) poisoning :

Diagnosis is made by anamnesis, physical examination, and blood tests showing other signs of poisoning.

Aspirin poisoning treatment :

  • The patient’s vital signs are evaluated. Respiratory support is given as needed, vascular access is kept open. Blood gas monitoring is done. Fluid supplementation is started.
  • Benzodiazepines can be used for seizures.
  • Gastric lavage (gastric lavage) with activated charcoal can be applied to patients treated within the first 3 hours.

The main goal of treatment is urinary excretion of salicylate and reduction of its blood concentration.

Tricyclic antidepressant poisoning: 

Tricyclic antidepressants are used in diseases such as depression, panic disorder, obsessive-compulsive disorder, attention deficit/hyperactivity syndrome, enuresis. Imipramine, desipramine, clomipramine, amitriptyline, nortriptyline, opipramol are drugs in this group.



Tri-risk antidepressant poisonings are mostly suicidal in adults. It is the most common cause of death due to high-dose drug intake.

Required doses for tricyclic antidepressant poisoning :

Intoxication symptoms are seen above 5 mg/kg dose. Poisonings over 10 mg/kg are life-threatening. More than 1 gr/kg is fatal.

Tri-risk antidepressant poisoning symptoms i:

  • Mild increase in blood pressure in the early period, low blood pressure in the later period,
  • Heart rhythm disorders,
  • Fire,
  • Growth in pupils,
  • Dry mouth,
  • Urinary incontinence,
  • Respiratory problems,
  • Increase in heart rate in the early period, decrease in the late period,
  • Seizures,
  • Consciousness changes,

Diagnosis of tririsk antidepressant poisoning :

Diagnosis can be easily made by anamnesis and ECG findings. QRS duration is prolonged on EKG.

Tricyclic antidepressant poisoning treatment :

  • The patient’s vital signs are checked. Respiratory support is provided if needed. The vascular access is kept open. Benzodiazepines can be used for seizures.
  • Gastric lavage with activated carbon can be applied.
  • The patient is monitored for cardiac rhythm disorders.

Transient serotonin reuptake inhibitors (SSRI) poisoning: 

It is a group of drugs that have recently been used more frequently in the treatment of depression, obsessive-compulsive disorder, and anxiety, better tolerated than tricyclic antidepressants, and have less toxic effects. Citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and zimelidine are in this group.

Seratonin Syndrome may develop due to excessive stimulation of serotonin receptors. Many drugs other than SSRIs can improve serotonin syndrome.

Doses required for SSRI poisoning :

In case of taking more than 30 times the daily dose, symptoms of poisoning are seen. Vomiting, tremors in the hands may develop in 50-75 times more intake. It can be fatal in 150 times and more intake, if there is an additional intake of other drugs.

Symptoms of SSRI poisoning :

  • Fluoxetine: It may not cause symptoms even at high doses. Nausea, vomiting, somnolence, tremor, agitation, and increased heart rate are most common.
  • Sertraline: It may not cause symptoms even at high doses. Nausea, vomiting, drowsiness, agitation, tremor, increased or decreased heart rate are most common.
  • Paroxetine: Nausea, vomiting, somnolence, tremor, dizziness, increased heart rate may be seen.
  • Fluvoxamine: Nausea, vomiting, diarrhea, abdominal pain, dizziness, drowsiness, tremor, dilated pupils, increased heart rate may be seen.
  • Citalopram: It is the most toxic of the SSRI group drugs. Mild symptoms (nausea, vomiting, tremor, drowsiness, dizziness, increased heart rate) may be seen in doses up to 600 mg.

Diagnosis of SSRI poisoning :

Diagnosis can be made by anamnesis, physical examination, ECG findings and other toxicological tests. There may be QT prolongation on the EKG.

SSRI poisoning treatment :

The patient’s vital signs are monitored. Although not usually needed, respiratory support and keeping the vascular access open are provided if needed. Gastric lavage with activated charcoal may be required. Generally supportive treatment is applied.

Beta blocker poisoning: 

Beta blocker drugs are used in diseases such as high blood pressure, angina pectoris, heart rhythm disorders, migraine, glaucoma. They reduce heart rate and lower blood pressure. Intoxication may occur with a single use in high doses, and in some cases, interaction with other drugs may be responsible for poisoning.



Proranolol is responsible for most beta-blocker poisonings.

Required doses for beta blocker poisoning :

Intoxication symptoms are seen at doses 2-3 times the daily dose.

Symptoms of beta blocker poisoning :

  • Blood pressure decrease,
  • High blood pressure (pindolol, acebutolol, celiprolol and oxprenolol),
  • Decreased heart rate,
  • Increased heart rate (pindolol, acebutolol, celiprolol and oxprenolol),
  • Heart rhythm disorders,
  • Heart failure,
  • Consciousness disorders,
  • Fainting,
  • Visual disturbances,
  • Excessive sweating,
  • Seizures,
  • Decrease in blood glucose level,
  • Respiratory problems,

Diagnosis of beta blocker poisoning :

Diagnosis is made by anamnesis, physical examination and general toxicological tests, ECG.

Beta blocker poisoning treatment :

The patient’s vital signs are evaluated. Respiratory support is given if needed. The vascular access is kept open. Blood gases and glucose levels are monitored. Gastric lavage can be done with activated carbon. The basis of treatment is supportive therapy.

Calcium channel blockers poisoning: 

Calcium channel blockers are drugs used in the treatment of high blood pressure, angina pectoris and heart rhythm disorders.

Calcium channel blocker poisoning may develop due to high-dose drug use or suicidal use. The most common poisonings are amlodipine, verapamil and diltiazem. When calcium channel blockers are used together with diuretics or nitrates, their effect increases and the risk of poisoning increases.

Required doses for calcium channel blockers poisoning :
  • The minimum toxic dose for verapamil is 720 mg, the average toxic dose is 2.708 mg,
  • The minimum toxic dose for diltiazem is 420 mg, the average toxic dose is 2.167 mg,
  • The minimum toxic dose for nifedipine is 50 mg, the average toxic dose is 245 mg.
  • In long-term calcium channel blockers, intoxication symptoms can be seen in twice the daily dose.

Symptoms in calcium channel blockers poisoning :

  • Severe hypotension,
  • Decreased heart rate,
  • Heart rhythm disorders,
  • Nausea, vomiting,
  • Increase in blood glucose level,
  • Consciousness disorders,

Diagnosis of calcium channel blockers poisoning :

Diagnosis can be made by anamnesis and physical examination findings. Toxicological tests are helpful. PR and QT times are prolonged on EKG.

Treatment of calcium channel blocker poisoning :

  • The patient’s vital signs are evaluated. If needed, oxygen support is provided and the vascular access is kept open.
  • Calcium is used as an antidote.
  • The treatment is applied in the form of supportive treatment under hospital conditions.

Benzodiazepine poisoning: 

Benzodiazepines are a group of drugs used in a wide range of diseases such as depression, anxiety disorders, sleep problems and seizures. It is evaluated in three groups:



Short-acting : Midazolam, triazolam.

Intermediate action : Oxazepam, alprazolam, lorazepam, temazepam, nitrazepam, flunitrazepam.

Long-acting : Diazepam, chlordiazepoxide, clorazepate, prazepam, halazepam, medazepam, flurazepam, quazepam.

Symptoms of benzodiazepine poisoning :

  • Sleeping state,
  • Visual disturbances (double vision etc.),
  • speech disorders,
  • dizziness,
  • Ataxia,
  • consciousness disorders,
  • seizures,

Mostly death is not seen.

Diagnosis in benzodiazepine poisoning :

The diagnosis of the disease is made by anamnesis, physical examination, and detection of benzodiazepine or its metabolites levels in blood and urine.

Treatment of benzodiazepine poisoning :

The patient’s vital signs are evaluated. If necessary, respiratory support is given and the vascular access is kept open. Flumazenil is used as an antidote for excessive doses.

Opioid poisoning:

It is one of the most common addiction factors. Its analgesic and mild sedative effects are used in medicine. However, there is often abuse. It has serious side effects that can be life-threatening.

It is broadly divided into three groups:

  • Natural opioids : Morphine, codeine
  • Semi-synthetic opioids : Heroin, oxycodone, hydromorphine
  • Synthetic opioids : Pethidine, fentanyl, tramazol, methadone

Symptoms of opioid poisoning :

  • nausea, vomiting,
  • Skin itching, urticaria,
  • speech disorder,
  • shaking hands,
  • breathing difficulties,
  • blood pressure drop,
  • decrease in blood glucose level,
  • Decreased heart rate,
  • muscle contraction,
  • Hearing problems,
  • Miosis of the eyes (shrinking of the pupils),

Diagnosis of opioid poisoning :

The diagnosis of the disease can be made with a good anamnesis and physical examination. Urine opioid screening, liver and kidney functions should be monitored.

Treatment for opioid poisoning :

  • The patient’s vital signs are evaluated. Respiratory support, keeping the vascular access open, and follow-up in terms of heart diseases are required.
  • Naloxane is given as an antidote.
  • Supportive treatment is applied.



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