POISONING DUE TO AN OVER-THE-COUNTER HYPNOTIC, SLEEP-QIK (HYOSCINE, CYPROHEPTADINE, VALERIAN)

The clinical features and risk of hepatotoxicity of 'Sleep-Qik'(valeri an dry extract 75 mg, hyoscine hydrobromide 0.25 mg, cyproheptadine hy drochloride 2 mg) were determined in 23 patients treated in our hospit al between 1988 and 1991. The main clinical problems were central nerv ous system depression and anticholinergic poisoning. There was no clin ical evidence of acute hepatitis in the 23 patients after taking an av erage of 2.5 g of valerian (range 0.5 to 12 g). There was no evidence of subclinical liver damage in 12 patients who had routine liver funct ion tests performed approximately 6-12 hours after ingestion. Delayed onset of severe liver damage was excluded in 10 patients in whom a tel ephone follow-up was possible. However, subclinical liver dysfunction in the acute stage (onset after 12-24 hours) and in the intervening pe riod after discharge from hospital could not be excluded. To establish the risk of hepatotoxicity in long-term users and in those taking an overdosage of valerian, a much larger study of longer duration with se rial liver function tests is clearly needed.