Overdosage with the 4-aminoquinolines is dangerous particularly in infants, as little as 1-2g having proved fatal. The symptoms of over dosage may include headache, visual disturbances, cardiovascular collapse, convulsions, hypokalaemia, and rhythm and conduction disorders, followed by sudden and early respiratory and cardiac arrest. Since these effects may appear soon after taking a massive dose, treatment should be prompt and symptomatic. The stomach should be immediately evacuated, either by emesis or by gastric lavage. Activated charcoal in a dose at least five times of the overdose may inhibit further absorption if introduced into the stomach by tube following lavage and within 30 minutes of ingestion of the overdose. Consideration should be given to administration of parenteral diazepam in cases of over dosage; it has been shown to be beneficial in reversing chloroquine cardiotoxicity. Respiratory support and shock management should be instituted as necessary.
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