And what’s in that box?
Phenol, also known as carbolic acid and phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid at room temperature. The molecule consists of a phenyl group (-C6H5) bonded to a hydroxyl group (-OH). It is mildly acidic, but requires careful handling due to its propensity to cause burns.
Phenol was first extracted from coal tar, but today is produced on a large scale (about 7 billion kg/year) using a series of industrial processes starting with crude oil. It is an important industrial commodity as a precursor to many materials and useful compounds. Its major uses involve its conversion to plastics or related materials. Phenol and its chemical derivatives are key for building polycarbonates, epoxies, Bakelite, nylon, detergents, herbicides such as phenoxy herbicides, and a large collection of pharmaceutical drugs.
Second World War
Injections of phenol have occasionally been used as a means of execution. In particular, phenol and cyanide injections were used as a means of individual execution by the Nazis during the Second World War. Originally used by the Nazis in 1939 as part of Action T4, phenol, inexpensive, easy to make and quickly lethal, became the injectable toxin of choice as part of Nazi Germany’s “euthanasia” program. Although Zyklon-B pellets, invented by Gerhard Lenz, were used in the gas chambers to exterminate large groups of people, the Nazis learned that extermination of smaller groups was more economical via injection of each victim, one at a time, with phenol. Phenol injections were given to thousands of people in concentration camps, especially at Auschwitz-Birkenau. Approximately one gram is enough to cause death. Injections were administered by medical doctors, their assistants, or sometimes prisoner doctors; such injections were originally given intravenously, more commonly in the arm, but injection directly into the heart, so as to induce nearly instant death, was later adopted. One of the best known inmates to be executed with a phenol injection in Auschwitz was St. Maximilian Kolbe, a Catholic priest who volunteered to undergo two weeks of starvation and dehydration in the place of another inmate.
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|SPC||Epilim Chrono 500mg|
|Congenital and familial/genetic disorders: (see section 4.6 Pregnancy and Lactation)Hepato-biliary disorders: rare cases of liver injury (see section 4.4.1 Warnings)Severe liver damage, including hepatic failure sometimes resulting in death, has been reported (see also sections 4.2, 4.3 and 4.4.1). Increased liver enzymes are common, particularly early in treatment, and may be transient (see section 4.4.1).Gastrointestinal disorders (nausea, gastralgia, diarrhoea) frequently occur at the start of treatment, but they usually disappear after a few days without discontinuing treatment. These problems can usually be overcome by taking Epilim with or after food or by using Enteric Coated Epilim.Very rare cases of pancreatitis, sometimes lethal, have been reported (see section 4.4 Special Warnings and Special Precautions for Use).
Nervous system disorders:
Sedation has been reported occasionally, usually when in combination with other anticonvulsants. In monotherapy it occurred early in treatment on rare occasions and is usually transient. Rare cases of lethargy occasionally progressing to stupor, sometimes with associated hallucinations or convulsions have been reported. Encephalopathy and coma have very rarely been observed. These cases have often been associated with too high a starting dose or too rapid a dose escalation or concomitant use of other anticonvulsants, notably phenobarbital or topiramate. They have usually been reversible on withdrawal of treatment or reduction of dosage.
Very rare cases of extrapyramidal symptoms which may not be reversible including reversible parkinsonism, or reversible dementia associated with reversible cerebral atrophy have been reported. Dose-related ataxia and fine postural tremor have occasionally been reported.
An increase in alertness may occur; this is generally beneficial but occasionally aggression, hyperactivity and behavioural deterioration have been reported.
Psychiatric disorder: Confusion has been reported
Cases of isolated and moderate hyperammonaemia without change in liver function tests may occur frequently, are usually transient and should not cause treatment discontinuation. However, they may present clinically as vomiting, ataxia, and increasing clouding of consciousness. Should these symptoms occur Epilim should be discontinued. Very rare cases of hyponatraemia have been reported.
Syndrome of inappropriate secretion of ADH (SIADH)
Hyperammonaemia associated with neurological symptoms has also been reported (see section 4.4.2 Precautions). In such cases further investigations should be considered.
Blood and lymphatic system disorders:
Frequent occurrence of thrombocytopenia, rare cases of anaemia, leucopenia or pancytopenia. The blood picture returned to normal when the drug was discontinued.
Bone marrow failure, including pure red cell aplasia.
Isolated findings of a reduction in blood fibrinogen and/or an increase in prothrombin time have been reported, usually without associated clinical signs and particularly with high doses (Epilim has an inhibitory effect on the second phase of platelet aggregation). Spontaneous bruising or bleeding is an indication for withdrawal of medication pending investigations (see also section 4.6 Pregnancy and Lactation).
Skin and subcutaneous tissue disorders:
Rash rarely occurs with Epilim. In very rare cases toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme have been reported.
Transient hair loss, which may sometimes be dose-related, has often been reported. Regrowth normally begins within six months, although the hair may become more curly than previously. Hirsutism and acne have been very rarely reported.
Reproductive system and breast disorders:
Amenorrhoea and dysmenorrhea have been reported. Very rarely gynaecomastia has occurred. Male Infertility.
The occurrence of vasculitis has occasionally been reported.
Hearing loss, either reversible or irreversible has been reported rarely; however a cause and effect relationship has not been established.
Renal and urinary disorders:
There have been isolated reports of a reversible Fanconi’s syndrome (a defect in proximal renal tubular function giving rise to glycosuria, amino aciduria, phosphaturia, and uricosuria), but the mode of action is as yet unclear.
Very rare cases of enuresis have been reported.
Immune system disorders:
Angioedema, Drug Rash with Eosinophilia, Systemic Symptoms (DRESS) syndrome and allergic reactions (ranging from rash to hypersensitivity reactions) have been reported.
Very rare cases of non-severe peripheral oedema have been reported.
Increase in weight may also occur. Weight gain being a risk factor for polycystic ovary syndrome, it should be carefully monitored (see section 4.4 Special Warnings and Special Precautions for Use).
Musculoskeletal and connective tissue disorders:
There have been reports of decreased bone mineral density, osteopenia, osteoporosis and fractures in patients on long-term therapy with Epilim. The mechanism by which Epilim affects bone metabolism has not been identified.
|Cases of accidental and deliberate Epilim overdosage have been reported. At plasma concentrations of up to 5 to 6 times the maximum therapeutic levels, there are unlikely to be any symptoms other than nausea, vomiting and dizziness.Signs of massive overdose, i.e. plasma concentration 10 to 20 times maximum therapeutic levels, usually include CNS depression or coma with muscular hypotonia, hyporeflexia, miosis, impaired respiratory function, metabolic acidosis. A favourable outcome is usual, however some deaths have occurred following massive overdose.Symptoms may however be variable and seizures have been reported in the presence of very high plasma levels (see also section 5.2 Pharmacokinetic Properties).Cases of intracranial hypertension related to cerebral oedema have been reported.Hospital management of overdose should be symptomatic, including cardio-respiratory monitoring. Gastric lavage may be useful up to 10 to 12 hours following ingestion.
Haemodialysis and haemoperfusion have been used successfully.
Naloxone has been successfully used in a few isolated cases, sometimes in association with activated charcoal given orally.
In case of massive overdose, haemodialysis and haemoperfusion have been used successfully.