Trimetazidine as a potential adjuvant therapy in acute aluminum phosphide poisoning: A randomized controlled clinical trial - 03/04/26

Doi : 10.1016/j.toxac.2026.03.109

Nadia E. Helal ^a , Asmaa Fady Sharif ^a,^b,⁎ , Tarek Abdel Hay Mostafa ^c , Bsant Safwat Kasem ^d , Samah M. Elbastawesy ^a

^a Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt

^b Clinical Medical Sciences Department, College of Medicine, Riyadh, Kingdom of Saudi Arabia

^c Department of Anesthesiology and Critical Care, Faculty of Medicine–Tanta University, Tanta, Egypt

^d Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt

^* Corresponding author. Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, 31111 Tanta, Egypt. Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University Tanta 31111 Egypt

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 03 April 2026

Summary

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 h 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 h, 16 and 24 h 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.

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Keywords : Aluminum phosphide Poisoning, Trimetazidine, Mortality, Cardiotoxicity, Endotracheal intubation