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Toxin Induced Altered Level of Consciousness CausesAka: Drug Induced Altered Level of Consciousness Causes

Risk factors for Altered Level of Consciousness
1. Age over 60 years old
Medications: Neuro-Psychopharmacologic Agents
1. Anticholinergics (e.g. Atropine)
  1. See Anticholinergic Medications
  2. See Anticholinergic Toxicity
2. Anticonvulsants
  1. Delirium or Confusion
  2. Cognitive Impairment
  3. Amnesia
3. Barbiturates
  1. Delirium or Confusion
  2. Incoordination
  3. Barbiturate withdrawal related signs
4. Benzodiazepines (esp. high dose longer acting agents)
  1. Cognitive Impairment
  2. Amnesia
  3. Sedation
  4. Pseudo-Dementia
  5. Incoordination
  6. Benzodiazepine Withdrawal (e.g. Delirium)
    1. Higher risk with shorter acting Benzodiazepines
5. Tricyclic Antidepressants (e.g. Elavil, Doxepin)
  1. Delirium
  2. Confusion
  3. Impaired Memory
6. Selective Serotonin Reuptake Inhibitors (SSRIs)
  1. Decreased concentration
  2. Confusion associated with SIADH
7. Antipsychotics
  1. Effects
    1. Delirium or confusion
    2. Cognitive Impairment
    3. Amnesia
  2. High risk
    1. Chlorpromazine
    2. Thioridazine
    3. Clozapine
  3. Low risk
    1. Risperidone
8. Lithium
  1. Organic brain syndrome
9. Zolpidem (Ambien)
  1. Memory Impairment
  2. Hallucinations
Medications: Analgesics
1. Salicylates (in overdosage)
2. NSAIDs (especially Indomethacin)
  1. Delirium or confusion
  2. Cognitive Impairment
  3. Delirium
3. Narcotic Analgesics (esp. Demerol, Fentanyl Patch)
  1. Delirium or confusion
  2. Cognitive Impairment
Medications: Drugs of abuse and Toxins
1. Alcohol
2. Hallucinogens
3. Opiates (See Analgesics above)
4. Carbon Monoxide
5. Cyanide
6. Heavy metals
7. Cholinergic Toxicity (e.g. Organophosphate Poisoning)
Medications: CardioPulmonary agents
1. Beta Blockers
  1. Confusion
  2. Cognitive Impairment
2. Calcium Channel Blockers
  1. Cognitive decline
3. Acetazolamide (Diamox)
  1. Confusion
4. Digoxin
  1. Confusion or Delirium
5. Disopyramide (Norpace)
  1. Psychosis (anticholinergic related)
6. Ethacrynic acid
  1. Confusion
7. Nitroprusside
  1. Confusion or Delirium
8. Procainamide
  1. Delirium
9. Quinidine
  1. Confusion
  2. Psychosis
10. Theophylline
  1. Psychosis
Medications: Infectious Disease Agents
1. Beta lactam antibiotics
  1. Confusion
2. Fluoroquinolones
  1. Neurologic stimulation
  2. Confusion
3. Acyclovir
  1. Confusion
4. Mefloquine
  1. Confusion
  2. Psychosis
5. Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
  1. Delirium
  2. Psychosis
Medications: Antihistamines
1. H1 blocker
  1. Effects
    1. Decreased attention
    2. Decreased Concentration
  2. High risk: Sedating Antihistamine
  3. Low risk: Fexofenadine, Loratadine
2. H2 Blocker (esp. Cimetidine)
  1. Delirium or confusion
Medications: Miscellaneous
1. Corticosteroids (Prednisone at doses above 60 mg)
  1. Confusion of Delirium
  2. Memory Impairment
2. Baclofen
  1. Psychosis
3. Cyclobenzaprine (Flexeril)
  1. Delirium or confusion
4. Cyclosporine
  1. Confusion
5. Fenfluramine
  1. Confusion
6. Interferon alpha
  1. Confusion
  2. Memory Impairment
7. Omeprazole (Prilosec)
  1. Confusion
  2. Agitation
  3. Memory Impairment
References
1. Gray (1999) Drug Saf 21:101
2. Moore (1999) Drugs Aging 15:15

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:19:07 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.