CJEM Articles: antidotes
Displaying 1-2 of 2 results
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May
2002
4
3
Tammy L. Hall
The management of ethylene glycol poisoning is reviewed, with a focus on the use of the new antidote fomepizole. Ethylene glycol is a widely used industrial agent that is also easily obtained commercially, usually as radiator antifreeze. Ingestion of as little as 30 to 60 mL can result in death or serious permanent disability. Traditional management of poisoning includes the use of ethanol, with or without hemodialysis. Activated charcoal is not indicated, and gastric lavage may be beneficial only in the first hour after ingestion. Cofactors such as pyridoxine and thiamine may be beneficial in patients deficient in these vitamins. A new antidote, fomepizole, has recently been approved for use in Canada. Like ethanol, it is a competitive inhibitor of alcohol dehydrogenase. Potential benefits of fomepizole include its ease of administration and lack of serious adverse effects. Fomepizole may be recommended over ethanol in situations in which avoidance of ethanol-induced side effects is imperative or when ethanol is not readily available. Further studies are required to verify its comparative efficacy and cost-effectiveness compared to ethanol.
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January
2002
4
1
Jacques S. Lee, Jeffrey S. Eisen, Marco L.A. Sivilotti, Robert G. Peterson
Background: Most emergency departments (EDs) have deficiencies in the type and quantity of antidotes readily available to treat severely poisoned patients. Undue emphasis on the purchase price of several expensive antidotes such as anti-digoxin Fab fragments and fomepizole may contribute to this problem by creating the perception that comprehensive antidote stocking is too costly for smaller centres. For rarely used medications, however, purchase price alone is an insufficient estimate of cost.
Objective: To model the initial and annual maintenance cost needed for small to medium Canadian EDs to maintain an appropriate stock of essential antidotes.
Methods: A budget impact analysis was performed from the perspective of the ED pharmacy, using the following input variables: essential antidotes and recommended dose/formulation, estimated frequency of administration, price, shelf-life, and supplier replacement policy for expired drug.
Results: Frequency of use, shelf-life, and especially replacement policy for unused expired antidote are major determinants of cost. Remote hospitals that need to stock sufficient antidote to manage a patient for the initial 4 hours after presentation would incur only modestly increased costs compared to hospitals within one hour of a referral centre.
Conclusions: While other factors (antidote efficacy, safety and available alternate therapy) need to be considered, the cost of maintaining antidote availability is not determined primarily by purchase price. A change in supplier policy to free replacement on expiry for fomepizole and cyanide antidotes would have a considerable effect on making these antidotes less costly for smaller Canadian EDs.
