What is the first-line treatment for PCP (phencyclidine) overdose?

• A. Flumazenil
• B. Haloperidol
• C. Benzodiazepines
• D. Naloxone

Answer: (C)

The main idea is that PCP overdose causes severe agitation and an overactive sympathetic state, often with risk of seizures, due to NMDA receptor antagonism. The best initial treatment to calm agitation, reduce autonomic arousal, and help prevent seizures is a benzodiazepine. These meds enhance GABA activity, providing sedation, anxiolysis, and anticonvulsant effects, which directly address the dangerous symptoms of PCP intoxication.

Flumazenil blocks benzodiazepine effects and can precipitate withdrawal or seizures in someone with PCP intoxication, so it’s not used as a reversal agent here. Naloxone targets opioid overdose, which is not the issue in PCP poisoning. Haloperidol, an antipsychotic, may be considered if agitation persists, but it is not first-line because it doesn’t adequately address dissociation and agitation and it carries risks of extrapyramidal symptoms and seizures in the setting of PCP intoxication; benzodiazepines are preferred for initial management.