Introduction: Acute aluminum phosphide (AlP) poisoning is a challenging emergency with significant mortality. This study aimed to evaluate the efficacy of Trimetazidine dihydrochloride (TMZ) in reducing in-hospital mortality, need for endotracheal intubation (ETI), and vasopressors in the first 24 hours after exposure to AlP.

Methods: A double-blinded randomized phase II clinical trial was performed, enrolling 40 adult patients exposed to AlP; 20 patients were allocated into either group. The Control group received the standard treatment, while the Intervention group received repeated doses of TMZ in addition to standard care. Twenty mg of TMZ was administered on admission, 8 hours, 16 and 24 hours post admission.

Results: The mean age of the studied patients was approximately 24 years. The overall mortality was 70%, 67.5% of patients needed ETI, and 72.5% were given vasopressors. The Intervention group showed a 13.3% reduction in mortality and a 20% reduction in need for ETI, with a lower proportion of patients receiving vasopressors. The Intervention Group exhibited a more favorable trajectory in arterial pH compared with the Control Group (β = 0.028; p = 0.030). The lactate increased less in the intervention group (β = −1.8; p = 0.020). Though CK-MB and troponin rose over time, this increase was significantly smaller in the Intervention group (p < 0.001), indicating a treatment-related attenuation of cardiotoxicity.

Conclusion: While the administration of TMZ did not achieve significant differences in mortality or intubation rates, it suggested potential clinical benefits in improving vital hemodynamics and cardiac outcomes in AlP poisoning.