Thirteen years of oxcarbazepine exposures reported to US poison centers

2016 ◽  
Vol 35 (10) ◽  
pp. 1055-1059 ◽  
Author(s):  
HA Spiller ◽  
J Strauch ◽  
SJ Essing-Spiller ◽  
G Burns
Keyword(s):  
Adult Population ◽  
Care Facility ◽  
Health Care Facility ◽  
Cardiovascular Complications ◽  
Major Effect ◽  
Clinical Effects ◽  
Electrolyte Disturbance ◽  
Generalized Seizures ◽  
Poison Centers ◽  
National Poison Data System

Objectives: Oxcarbazepine (OXC) is a 10-keto analogue of carbamazepine used in patients with partial and secondary generalized seizures. We evaluated ingestions of OXC reported to US poison centers for adverse effects from supratherapeutic doses and/or overdose. Method: Retrospective analysis of data reported to National Poison Data System from single-substance OXC ingestions between January 2000 and December 2012. Results: There were 18,867cases with a mean of 1451 exposures/year. The patients were predominantly adults with 5464 exposures in children <6 years (29%). The most commonly reported clinical effects were drowsiness ( n = 4703, 25%), vomiting ( n = 1559, 8%), tachycardia ( n = 590, 3%), agitated ( n = 342, 1.8%), hypotension ( n = 178, 0.9%), electrolyte disturbance ( n = 153, 0.8%), coma (n = 156, 0.8%), and seizures ( n = 121, 0.6%). There were 176 patients with a major effect of which 31 involved were children and 1728 (9%) patients with moderate effects of which 300 involved were children. Five deaths were reported in adults. Intentional exposure (e.g. suicide) was the reason for exposure in 68% of patients with major effects and in all fatalities. Fifty-three percent of adults and 38% of children were managed in a health-care facility (HCF). HCF utilization levels remained consistent. Discussion: Severe outcomes appear to be infrequent (<1%). Unlike other anticonvulsants OXC does not appear to be proconvulsant in overdose. Conclusion: Serious outcomes for OXC overdoses are unlikely in the pediatric patient. With only mild symptoms likely, observation at home may be appropriate for the majority of cases. In the adult population there appears to be few neurologic and cardiovascular complications even in the intentional exposure.

Vitamin D exposures reported to US poison centers 2000–2014

2015 ◽  
Vol 35 (5) ◽  
pp. 457-461 ◽  
Author(s):  
HA Spiller ◽  
TF Good ◽  
NE Spiller ◽  
A Aleguas
Keyword(s):  
Vitamin D ◽  
Care Facility ◽  
Health Care Facility ◽  
Major Effect ◽  
Clinical Effects ◽  
Medical Outcome ◽  
Single Substance ◽  
Poison Centers ◽  
Neurological Effects ◽  
National Poison Data System

There has been an increased use of vitamin D both by prescription and by the public as a widely available supplement. We evaluated 15 years of single-substance vitamin D exposures to US poison centers. Methods: Retrospective analysis of data from the National Poison Data System (NPDS) to evaluate clinical effects, trends, and outcomes of exposures to vitamin D over the period January 1, 2000 through June 30, 2014. Cases were limited to exposures involving vitamin D as a single substance. Multiple vitamin products that may have included vitamin D were not included in this study. Results: From 2000 through June 30, 2014, there were 25,397 human exposures to vitamin D reported to NPDS. There was a mean of 196 cases per year from 2000 to 2005, followed by a 1600% increase in exposures between 2005 and 2011 to a new annual mean of 4535 exposures per year. The mean and median ages were 23.4 years and 10 years, respectively. There were no fatalities, but five (0.02%) major effect outcomes. Serious medical outcomes (major or moderate outcome) were infrequent, ranging from 2 patients/year to 22 patients/year. Clinical effects were primarily gastrointestinal (0.7–1.5%) and mild neurological effects (0.2–0.4%). There was a decline in the percentage of patients treated in a health care facility and of patients with serious medical outcome. Conclusion: Despite the enormous increase in number of exposures, there was not a significant increase in patients with a serious medical outcome. Rare severe outcomes may occur.

Review of toxicity and trends in the use of tiagabine as reported to US poison centers from 2000 to 2012

2015 ◽  
Vol 35 (2) ◽  
pp. 109-113 ◽  
Author(s):  
HA Spiller ◽  
D Wiles ◽  
JL Russell ◽  
MJ Casavant
Keyword(s):  
Suicide Attempt ◽  
Suicide Ideation ◽  
Temporal Trends ◽  
Care Facility ◽  
Health Care Facility ◽  
High Rate ◽  
Clinical Effects ◽  
Gamma Aminobutyric Acid ◽  
Poison Centers ◽  
National Poison Data System

Background: Tiagabine is a novel antiepileptic that acts by increasing synaptic and extracellular gamma-aminobutyric acid concentrations. Information concerning overdose of tiagabine is limited. After introduction, an increasing number of off-label uses suggested that tiagabine use would increase. However in 2005 and 2008, warnings from the Food and Drug Administration (FDA) were issued on the risk of seizures in non-epileptic and increased suicide ideation. We evaluated the temporal trends associated with these two warnings as well as clinical outcomes from tiagabine overdose. Method: A retrospective review of all single substance tiagabine exposures in National Poison Data System (NPDS) from 2000 to 2012. Results: A total of 2147 patients had ingested tiagabine, with a mean of 165 year−1. This was disproportionally distributed, with a steep rise leading up to 2004 (max 559 year−1) and then a significant decline ( p < 0.05) between 2005 and 2006. The number of cases reported to NPDS mirrored the sales of tiagabine. Clinical effects were predominantly neurological, with the most commonly reported effects being drowsiness (27%), agitation (19%), confusion (12%), seizures (11%), and tachycardia (10%). In all, 758 patients (35%) showed a major or moderate medical outcome, with no deaths reported. A disproportionate share of the major outcomes was in the suicide attempt group (73%). The majority of patients (75%) were treated in a health-care facility (HCF). Conclusions: The HCF usage is likely due to high rate of symptomatic patients (59%) and the large proportion of suicide attempt cases. The frequency of tiagabine cases in NPDS mirrored pharmaceutical sales, with steep declines temporally related to the 2005 FDA warning.

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.

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.

Prevalence and Consequences of the Nonmedical Use of Amphetamine Among Persons Calling Poison Control Centers

2019 ◽  
Vol 23 (11) ◽  
pp. 1219-1228 ◽  
Author(s):  
Stephen V. Faraone ◽  
Jonathan Hess ◽  
Timothy Wilens
Keyword(s):  
Suicide Attempts ◽  
Care Facility ◽  
Health Care Facility ◽  
Oral Exposure ◽  
Poison Control ◽  
Clinical Effects ◽  
Medical Outcomes ◽  
Nonmedical Use ◽  
National Poison Data System ◽  
The U.S

Objective: To describe consequences of the nonmedical use (NMU) of prescription amphetamines (AMPs). Method: Data from the U.S. National Poison Data System yielded four groups: intravenous NMU ( IV NMU) intentionally injected AMP, Nasal NMU intentionally inhaled AMP but did not inject, Oral NMU intentionally ingested AMP, and controls reported unintentional oral exposure to AMP. Results: The Nasal NMU group was at greater risk of admission to a health care facility. All NMU groups were at greater risk for adverse clinical effects. IV NMU had the greatest number of adverse effects, followed by Nasal and Oral NMU. Nasal NMU had a greater risk for major medical outcomes versus Oral NMU. The IV NMU group was 21.9 times more likely to die from AMP NMU than controls. Oral NMU conferred a significantly greater risk of suicide attempts. Conclusion: Oral and nonoral NMU of AMP are associated with significant risks of morbidity and mortality.

Redotex ingestions reported to Texas poison centers

2010 ◽  
Vol 29 (9) ◽  
pp. 789-791
Author(s):  
Mathias B Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
The United States ◽  
Minor Effect ◽  
Poison Center ◽  
Clinical Effects ◽  
Clinical Factors ◽  
Poison Centers ◽  
Moderate Effect

Although the multi-component weight loss supplement Redotex is banned in the United States, the supplement can be obtained in Mexico. The intent of this report was to describe the pattern of Redotex calls received by a statewide poison center system. Cases were all Redotex calls received by Texas poison centers during 2000—2008. The distribution of total calls and those involving ingestion of the supplement were determined for selected demographic and clinical factors. Of 34 total Redotex calls received, 55.9% came from the 14 Texas counties that border Mexico. Of the 22 reported Redotex ingestions, 77.3% of the patients were female and 45.5% 20 years or more. Of the 17 ingestions involving no coingestants, 52.9% were already at or en route to a health care facility, 41.2% were managed on site, and 5.9% was referred to a health care facility. The final medical outcome was no effect in 23.5% cases, minor effect in 5.9%, moderate effect in 11.8%, not followed but minimal clinical effects possible in 47.1%, and unable to follow but judged to be potentially toxic in 11.8%. Most Redotex calls to the Texas poison center system originated from counties bordering Mexico.

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.

Human exposures to pentobarbital–phenytoin combination veterinary drugs

2016 ◽  
Vol 36 (7) ◽  
pp. 755-761 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Lethal Effect ◽  
Major Effect ◽  
Veterinary Drug ◽  
Minor Effect ◽  
Exposure Site ◽  
Poison Centers ◽  
Exposure Routes

A combination of pentobarbital and phenytoin is used as a veterinary euthanasia drug. Because of its lethal effect, this study described pentobarbital–phenytoin combination veterinary drug human exposures reported to Texas poison centers during 2000–2015. Of 66 exposures, 73% involved female and 27% male patients. The distribution by patient age was 3% 0–5 years, 5% 6–19 years, 91% 20+ years, and 2% unknown. The most common routes were ocular (41%), ingestion (32%), injection (23%), and dermal (18%). The exposure reasons were unintentional (77%) and intentional (23%). The exposure site was the workplace (52%), patient’s own residence (38%), health-care facility (2%), and other/unknown (9%). The management site was managed on site (48%), at/en route to health-care facility (45%), referred to health-care facility (5%), and other (2%). The medical outcomes were no effect (23%), minor effect (30%), moderate effect (8%), major effect (8%), not followed nontoxic (3%), not followed minimal effects (24%), unable to follow potentially toxic (2%), and unrelated (3%). The most common adverse effects were ocular irritation/pain (18%), drowsiness/lethargy (15%), and coma (9%). The most common treatments were dilution/irrigation (70%), intravenous fluids (21%), and oxygen (14%). This study found few pentobarbital–phenytoin combination veterinary drug exposures were reported to Texas poison centers during a 16-year period. Although meant to be administered intravenously, the most common exposure routes were ocular and ingestion. Many of the exposures appeared to be unintentional and occurred at the workplace.

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.

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.

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