Toxic Fungi of Western North America

by Thomas J. Duffy, MD

Treatment of ibotenic acid/muscimole poisoning

Treatment is symptomatic and requires close monitoring of symptoms, fluid and electrolyte balance and, in severe cases, seizure precautions. Extremely rare reports of kidney or liver changes suggest poisoning from mixed collections. Thorazine-like compounds should be avoided, since they may decrease the seizure threshold. Medications for seizures include diphenylhydantoin, gabapentin and sodium valproate. Diazepam and barbiturates are faster acting anticonvulsants intravenously, but have caused paralysis and abnormal EEG changes in laboratory animals previously given isoxazoles. (114) Metoclopramide is a safe anti-emetic. It is probably best to manage any "highs" without any medication if possible. Many of these medications are GABA enhancers and might conceivably worsen any "lows" occurring after the excitatory effects. (115)