Pattern of ziprasidone exposures reported to Texas poison centers, 2001–2005

2008 ◽  
Vol 27 (4) ◽  
pp. 355-361 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Age Distribution ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Clinical Effects ◽  
Poison Control Centers ◽  
Poison Centers ◽  
The Mean

Information on potentially adverse exposures to the atypical antipsychotic drug ziprasidone is limited. This study described the pattern of exposures involving only ziprasidone (isolated exposures) reported to Texas poison control centers during 2001–2005. The mean dose was 666 mg. The patient age distribution was ≤5 years (11%), 6–19 years (30%), and ≥20 years (60%). The exposures were intentional in 53% of the cases. Seventy-five percent of the exposures were managed at health care facilities. The final medical outcome was classified as no effect for 39% of the cases and minor effects for 40% of the cases. Adverse clinical effects were listed for 53% of the patients; the most frequently reported being neurological (42%), cardiovascular (13%), and gastrointestinal (5%). The most frequently listed treatment was decontamination by charcoal (34%) or cathartic (28%). Potentially adverse ziprasidone exposures reported to poison control centers are likely to involve management at a health care facility and involve some sort of adverse clinical effect. With proper treatment, the outcomes of such exposures are generally favorable.

Celecoxib exposures reported to Texas poison control centers from 1999 to 2004

2006 ◽  
Vol 25 (5) ◽  
pp. 261-266 ◽  
Author(s):  
M B Forrester
Keyword(s):  
Health Care ◽  
Age Distribution ◽  
Health Care Facilities ◽  
Poison Control ◽  
Clinical Effects ◽  
Medical Outcome ◽  
Patient Age ◽  
Poison Control Centers ◽  
Care Facilities ◽  
The Mean

Concerns have been raised about the safety of celecoxib. This study described the pattern of exposures involving only celecoxib (isolated exposures) reported to Texas poison control centers from 1999 to 2004. The mean dose was 701 mg. The patient age distribution was 5 / 5 years (48%), 6 / 19 years (8%), and 20 years (44%). In 78% of cases, exposure was unintentional. Of the exposures, 74% were managed outside of health care facilities. The final medical outcome was classified as no effect for 82% of the cases, and minor effects for 12% of the cases. Adverse clinical effects were listed for 5% of the patients, the most frequently reported being rash (3%), drowsiness (3%), pruritis (2%), and vomiting (2%). The most frequently listed treatment was decontamination by dilution (43%) or food (32%). The majority of isolated celecoxib exposures could be managed outside of health care facilities, and the outcome was generally favorable.

Adult metaxalone ingestions reported to Texas poison control centers, 2000-2006

2009 ◽  
Vol 29 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Mathias B Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Minor Effect ◽  
Clinical Effects ◽  
Medical Outcome ◽  
Poison Control Centers ◽  
Few Data

Few data exist on potentially adverse metaxalone (Skelaxin®) ingestions in adults. All metaxalone ingestions involving patients aged ≥20 years during 2000-2006 were retrieved from Texas poison control centers. Exclusion criteria were lack of follow-up or multiple substance ingestion. Cases were analyzed for selected demographic and clinical factors. Of the 142 patients, 66.2% were female. Dose ingested was reported for 61 patients. Of those cases with a reported dose, distribution by management site was 29.5% on-site, 59.0% already at/en route to health care facility, and 11.5% referred to health care facility. Final medical outcome was ‘no effect’ for 50.8% cases, ‘minor effect’ for 31.1%, and ‘moderate effect’ for 18.0%. The more common adverse clinical effects reported were drowsiness (27.9%), tachycardia (6.6%), agitation (6.6%), nausea (4.9%), dizziness (4.9%), slurred speech (4.9%), and tremor (4.9%). A moderate medical outcome occurred in 13.6% of ingestions of ≤2400 mg and 20.5% of ingestions of >2400 mg. Management involved a health care facility in 18.2% of ingestions of ≤2400 mg and 100.0% of ingestions of >2400 mg. This study found that adult ingestions of higher doses of metaxalone, particularly >2400 mg, were associated with more serious medical outcomes and were managed at health care facilities. This study also proposes triage guidelines for when ingestions can be safely managed at home.

Immediate- and controlled-release zolpidem ingestions reported to Texas poison centers

2009 ◽  
Vol 28 (8) ◽  
pp. 505-509 ◽  
Author(s):  
Mathias B Forrester
Keyword(s):  
Controlled Release ◽  
Care Facility ◽  
Health Care Facility ◽  
Immediate Release ◽  
Poison Control ◽  
Clinical Effects ◽  
Control Center ◽  
Poison Control Centers ◽  
Poison Centers ◽  
The Mean

Zolpidem is available in immediate-release (IR) and controlled-release (CR) formulations. This investigation examined whether there were differences in zolpidem IR and CR ingestions reported to poison control centers. Zolpidem ingestions that did not involve coingestants reported to Texas poison control centers during 2005-2008 were identified. The ingestions were grouped by IR and CR formulations and compared with respect to demographic and clinical factors. There were 734 IR and 163 CR ingestions. The mean dose ingested was 92.9 mg and 104.6 mg, respectively. IR and CR cases were, respectively, 56.9% and 58.3% male, 54.6% and 49.7% age >19 years, 65.0% and 65.0% already at or en route to a health care facility when the poison control center was contacted, and 30.1% and 39.3% involved no effect. The most frequently reported adverse clinical effects were, for IR and CR, respectively, drowsiness (54.4% vs 42.3%), tachycardia (10.6% vs 11.7%), ataxia (6.3% vs 11.7%), slurred speech (6.3% vs 6.7%), vomiting (5.0% vs 5.5%) and hallucinations/delusions (4.9% vs 3.1%). The distribution of zolpidem IR and CR ingestions reported to Texas poison control centers were similar. However, zolpidem CR ingestions appeared less likely to result in drowsiness and hallucinations but more likely to result in ataxia.

Neonicotinoid insecticide exposures reported to six poison centers in Texas

2014 ◽  
Vol 33 (6) ◽  
pp. 568-573 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Minor Effect ◽  
Clinical Effects ◽  
Dermal Irritation ◽  
Flea Control ◽  
Neonicotinoid Insecticide ◽  
Poison Centers

Neonicotinoids are a relatively newer class of insecticide. Used primarily in agriculture, neonicotinoids are also used for flea control in domestic animals. Information on human exposures to neonicotinoids is limited. Neonicotinoid exposures reported to Texas poison centers during 2000–2012 were identified and the distribution by selected factors examined. Of 1,142 total exposures, most products contained imidacloprid (77%) or dinotefuran (17%). The exposures were seasonal with half reported during May–August. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). The distribution by patient age was 5 years or less (28%), 6–19 years (9%), 20 years or more (61%), and unknown (2%); and 64% of the patients were female. Of all, 97% of the exposures were unintentional and 97% occurred at the patient’s own residence. The management site was on-site (92%), already at/en route to a health care facility (6%), and referred to a health care facility (2%). The medical outcomes included no effect (22%), minor effect (11%), moderate effect (1%), not followed judged nontoxic (14%), not followed minimal effects (46%), unable to follow potentially toxic (1%), and unrelated effect (4%). The most commonly reported adverse clinical effects were ocular irritation (6%), dermal irritation (5%), nausea (3%), vomiting (2%), oral irritation (2%), erythema (2%), and red eye (2%). The most frequently reported treatments were dilution/wash (85%) and food (6%). In summary, these data suggest that the majority of neonicotinoid exposures reported to the poison centers may be managed outside of health care facilities with few clinical effects expected.

Adult glyburide ingestions reported to Texas poison control centers, 1998—2005

2007 ◽  
Vol 26 (7) ◽  
pp. 563-571 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

Limited information exists on potentially adverse adult glyburide ingestions reported to poison control centers. Using adult glyburide ingestions reported to Texas poison control centers during 1998—2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 126 cases identified, 49 (39%) involved serious outcomes. Serious outcomes were significantly more likely to occur with a maximum dose > 24 mg (RR 4.74, 95% CI 1.74—14.90) or >4 tablets (RR 3.27, CI 1.57—7.31), where the circumstances of the exposures involved self-harm or malicious intent (RR 2.44, CI 1.33—4.46), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR 12.89, CI 4.00—66.12) or referred to a health care facility by the poison control center (RR 12.21, CI 3.53—65.01). The severity of the outcome associated with adult glyburide ingestions depended on the dose and the circumstances of the ingestion. The management of patients with severe outcomes was more likely to involve health care facilities. Such information is useful for creating triage guidelines for the management of adult glyburide ingestions. Human & Experimental Toxicology (2007) 26: 563—571.

Pediatric lisinopril ingestions reported to Texas poison control centers

2007 ◽  
Vol 26 (2) ◽  
pp. 83-89 ◽  
Author(s):  
M.B. Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Medical Outcomes ◽  
Poison Control Centers ◽  
Factors Associated ◽  
Care Facilities

Lisinopril is not recommended for use by young children. This study attempted to identify factors associated with serious outcomes in pediatric lisinopril ingestions. Cases for this study were lisinopril ingestions by children age ≤5 years reported to Texas poison control centers during 1998- 2005. The percentage of cases involving serious medical outcomes was identified for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 691 total cases, 26 (3.8%) involved a serious outcome. Higher serious outcome rates were found with a max imum dose of >4 mg/kg (RR: 2.54, CI: 0.05-25.62), or > 80 mg (RR: 7.85; CI: 1.73-29.29),or five or more tablets (RR: 8.18; CI: 2.73-22.54), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR: 13.93; CI: 3.68-77.78),or referred to a health care facility by the poison control center (RR: 33.49; CI: 9.04-194.94). The management of patients with severe outcomes was more likely to involve health care facilities. This information is useful for drafting triage guidelines for the management of pediatric lisinopril ingestions. Human & Experimental Toxicology (2007) 26 , 83- 89

Adult lisinopril ingestions reported to Texas poison control centers, 1998—2005

2007 ◽  
Vol 26 (6) ◽  
pp. 483-489 ◽  
Author(s):  
Mathias B. Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

There is limited information on potentially adverse lisinopril ingestions reported to poison control centers. Using adult lisinopril ingestions reported to Texas poison control centers during 1998—2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 468 cases identified, 43 (9%) involved serious outcomes. The severity of the outcome associated with adult lisinopril ingestions depended on the dose and the circumstances of the ingestion. Thus, serious outcomes were significantly more likely to occur with a maximum dose >80 mg (RR 5.69, CI 2.43—13.33) or, if the dose was unknown, ≥3 tablets (RR 9.57, CI 2.39—54.97), where the circumstances of the exposures involved self-harm or malicious intent (RR 6.96, CI 3.65—13.31), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR 7.33, CI 3.09—17.85) or referred to a health care facility by the poison control center (RR 23.76, CI 10.62—55.67). The management of patients with severe outcomes was more likely to involve health care facilities. Such information is useful for creating of triage guidelines for the management of adult lisinopril ingestions. Human & Experimental Toxicology (2007) 26, 483—489

Escitalopram ingestions reported to Texas poison control centers, 2002—2005

2007 ◽  
Vol 26 (6) ◽  
pp. 473-482 ◽  
Author(s):  
M.B. Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

Limited information exists on potentially adverse escitalopram ingestions reported to poison control centers. Using isolated escitalopram ingestions reported to Texas poison control centers during 2002—2005, the proportion of cases involving serious medical outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 1179 cases identified, 234 (20%) involved serious outcomes. Serious outcomes were significantly more likely to occur with a maximum dose of >100 mg (RR 4.69, CI 2.52—9.29) or >5 tablets (RR 4.96, CI 2.94—8.93), where the circumstances of the exposures involved self-harm or malicious intent (RR 3.21, CI 2.42—4.29), or when the patient was already at or en route to a health care facility when the poison control center was contacted (RR 7.88, CI 4.31—15.79) or referred to a health care facility by the poison control center (RR 15.91, CI 8.78—31.64). The severity of the outcome associated with isolated escitalopram ingestions depended on the dose and the circumstances of the ingestion. The management of patients with serious outcomes were more likely to involve health care facilities. Such information is useful for creating triage guidelines for the management of escitalopram ingestions. Human & Experimental Toxicology (2007) 26 , 473—482

Adult metformin ingestions reported to Texas poison control centers, 2000–2006

2008 ◽  
Vol 27 (7) ◽  
pp. 575-583 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Poison Control ◽  
Medical Outcome ◽  
Limited Information ◽  
Poison Control Centers ◽  
Hypoglycemic Agent ◽  
The Mean

Metformin is an oral hypoglycemic agent used in the management of type 2 diabetes mellitus. Limited information exists on adult metformin ingestions reported to poison control centers. The distribution of adult metformin ingestions reported to Texas poison control centers during 2000–2006 was determined for various factors. In addition, triage guidelines for the management of isolated ingestions were drafted. Of 1528 total metformin ingestions, 58% involved coingestants. Of the 264 ingestions of metformin alone, where the final medical outcome was known, dose ingested was reported for 66%. The mean reported dose was 4739 mg (range 500–60,000 mg). Ingestions of ≤2500 mg and >5000 mg reported doses differed with respect to the proportion involving suspected attempted suicide (6% versus 81%), serious final medical outcome (3% versus 19%), and referral to a health care facility (3% versus 83%). Using 5000 mg as a threshold dose for referral to a health care facility, 91% of cases not already at or en route to a health care facility were managed according drafted triage guidelines.

An 11-year retrospective review of venlafaxine ingestion in children from the California Poison Control System

2015 ◽  
Vol 35 (7) ◽  
pp. 767-774 ◽  
Author(s):  
S Doroudgar ◽  
PJ Perry ◽  
GD Lackey ◽  
NG Veselova ◽  
HM Chuang ◽  
...  
Keyword(s):  
Health Care ◽  
Control System ◽  
Care Facility ◽  
Health Care Facility ◽  
Altered Mental Status ◽  
The United States ◽  
Poison Control ◽  
Minor Effect ◽  
Clinical Effects ◽  
Phone Calls

Venlafaxine is commonly used in the United States for approved and non-Food and Drug Administration–approved indications in adults. It is used off-label to treat children for psychiatric diagnoses. The aim of the study was to describe venlafaxine toxicities in children and to identify the venlafaxine dose per weight that correlates with toxicities. An 11-year retrospective study of venlafaxine ingestion in children was performed using the California Poison Control System (CPCS) database. Data was extracted from phone calls received by CPCS clinicians and follow-up phone calls made to assess the patient’s progress in a health-care setting. Inclusion criteria were venlafaxine ingestion cases reported to CPCS between January 2001 and December 2011, children aged 20 years and under, venlafaxine as the only ingested substance, managed in a health-care facility, and followed to a known outcome. Two hundred sixty-two cases met the study criteria. Common presentations included gastrointestinal (14.9%), altered mental status (13.7%), and tachycardia (13.4%). The majority of the cases resulted in no effect (51.5%) or minor effect (19.9%). The average estimated dose per weight was 18.3 mg/kg in all patients and 64.5 mg/kg in those experiencing moderate-to-severe adverse effects. Seizures occurred in only 4 of the 262 cases at doses ranging from 1500 to 7500 mg. Although the estimated dose per weight exceeded 10 mg/kg for the majority of the cases, only 12 cases resulted in moderate or severe outcomes. The majority of venlafaxine ingestion cases in children resulted in either no clinical effects or minor clinical effects.

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