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Symptoms of Overdose A large overdose causes: Drowsiness Intoxication Rapid onset of sleepiness Fluctuating consciousness (periodically waking/sleeping is a relatively typical phenomenon) Absence periods Nausea Vomiting Tremors Dizziness Muscle cramps Ataxia Choreoathetosis Brief unconsciousness Slow pulse Motor agitation Affect lability, aggression Rapid onset of sleepiness Fluctuating consciousness Unconsciousness, coma Small pupils, ophthalmoplegia (strabismus) Hypotension Bradycardia ECG changes, possible AV block I-III or high QRS amplitudes Irregular pulse Slow and irregular breathing, respiratory depression Generalized seizures Vomiting Risk of aspiration of stomach contents into the lungs Hypothermia ACUTE MANAGEMENT The treatment of acute overdose is primarily symptomatic, and no antidote exists